Post B-lynch uterine rupture: case report and review of literature.

Abstract

Postpartum hemorrhage (PPH) remains one of the three leading causes of maternal death and uterine atony accounts for 75–90 % of primary PPH. Apart from traditional conservative methods such as medical therapy, tamponades, the B-Lynch surgical technique has been widely used around the world. In 1997, Christopher B. Lynch devised these mechanical uterine compressing sutures to avoid hysterectomy in cases of severe PPH due to uterine atony, and since then, anecdotal evidence suggests that around 1,300 cases have been performed successfully worldwide including in India, Africa, North and South America, and Europe (Figs. 1, ​,22). Fig. 1 Ruptured uterus Fig. 2 Sutured uterus Case Report A 23-year G4P1L1A2 was admitted from casualty on November 5, 2011 with 4 months of amenorrhea and pain in the abdomen since the morning. She was very pale, had tachycardia, and a BP of 90/60 mmHg. There was abdominal tenderness and guarding. There was also a suprapubic transverse scar of a previous surgery. The uterine size could not be assessed due to extreme tenderness and guarding. At the time of the previous normal delivery, the patient had atonic PPH for which B-Lynch suturing was done. The suture material used for B-Lynch was Polyglactin No 1 (delayed absorbable suture material) on round body needle. The ultrasound showed moderate free fluid in the abdomen, the fetus lying outside the uterine cavity, and a 7 × 7 cm retro placental hemorrhage -s/o uterine rupture. Under general anesthesia, an exploratory laparotomy was performed. The uterine rupture was approximately 6 cm in length at the fundal region. The fetus with the amniotic sac lying out of ruptured site and around 1,500 ml of hemoperitoneum. The uterus was sutured with delayed absorbable sutures in three layers. Peritoneal lavage was given and an intraperitoneal drain was kept. The uterine height was marked and monitored postoperatively. She received five units of whole blood, fresh frozen plasma, and platelets intra- and postoperatively. The postoperative course was uneventful and she was discharged on seventh postoperative day. The risk of uterine rupture in future pregnancy was explained to the patient and her relatives.