B-Lynch suture in the treatment of postpartum hemorrhage due to uterine atony and impact on long-term fertility

Abstract

Objective To evaluate the effects of B-Lynch suture for postpartum hemorrhage due to uterine atony, and to clarify its influence on long-term fertility and next pregnancy outcome. Methods We retrospectively collected the medical records of 150 women who underwent B-Lynch suture during cesarean section due to intra-operative bleeding caused by uterine atony from January 1, 2006 to December 31, 2013 in Peking University First Hospital. Follow-up was carried out to assess postoperative menstruation and subsequent pregnancy outcomes. Results All the cases underwent B-Lynch suture which successfully retained the uterus. Satisfactory hemostasis was achieved in 131 women (87.3%) who underwent B-Lynch suture only, and in eighteen women (12.0%) who had bilateral uterine artery ascending branch ligation at the same time; and in one patient (0.7%) who underwent B-Lynch suture and uterine artery embolization four hours later due to poor uterine contraction. Of the 141 (94.0%) cases followed up after surgery, menstrual cycle was assessed in a total of 104 women: no changes in the menstrual cycle and bleeding volume were noted in 67 cases (64.4%), prolonged menstruation was observed in five cases (4.8%), menorrhagia in ten cases (9.6%), and hypomenorrhea in 22 cases (21.2%). Eleven women (23.9%) became pregnant and delivered in two to four years after the surgery, and all were full-term abdominal delivery. Conclusions B-Lynch suture is a simple, safe, and effective treatment for postpartum hemorrhage due to uterine atony, without significant change of menstruation. B-Lynch suture is not associated with infertility, and the postoperative pregnant outcome is good. Key words: Uterine inertia; Postpartum hemorrhage; Suture techniques; Fertility; Treatment outcome