Conservative management of uterine necrosis following bilateral uterine vessels ligation and B-Lynch suture: Long term follow up

Abstract

A 29-year-old second gravida, previous abortion with twins, was induced at 32 weeks because of severe pre-eclampsia. Emergency caesarean section was needed for the second of twins, at which time she had an atonic postpartum haemorrhage. Bilateral uterine vessel ligation followed by B-Lynch suture was undertaken due to failure of medical measures. Post-operatively she had a stormy course with high spiking temperature and distension of abdomen and on imaging suspected foreign body in the uterus or uterine necrosis. At laparotomy, there was 6 liters of foul-smelling peritoneal fluid, and there was a deep groove on the uterus with impending perforation and partial necrosis of the uterus. After removing the suture, the perfusion slowly resumed, and hysterectomy was deferred. After five months, she expelled a necrotic tissue of the uterine cast. After six months, she resumed menstruation, and after three years, she had an intrauterine pregnancy, and presently, at five years, she has regular menstruation.