Prophylactic B-Lynch suture (modified technique) versus prophylactic carbetocin and prophylactic oxytocin during cesarean section in women at high risk for atonic postpartum hemorrhage

Abstract

Objective The aim of this study was to compare the effect of prophylactic B-Lynch suture, carbetocin, and oxytocin in the prevention of atonic postpartum hemorrhage (PPH) following cesarean section in pregnant women at high risk for atonic PPH. Study design This randomized controlled prospective study was conducted on 453 pregnant women at a high risk of developing PPH scheduled to undergo cesarean section. They were randomized during cesarean section to either undergo prophylactic B-Lynch suturing, receive prophylactic 100 μg of intravenous carbetocin, or receive prophylactic 20 U of oxytocin intravenous infusion on 1000 ml saline at a rate of 250 ml/h. The primary outcomes included the mean operative blood loss, the occurrence of major obstetric hemorrhage (blood loss≥1000 ml), and the need for additional uterotonic agents or additional interventions to control bleeding. Secondary outcomes included objective changes in hemoglobin preoperatively and postoperatively, occurrence of severe anemia, need for blood transfusion, side effects (e.g. paralytic ileus), and postnatal hospital stay. Results Patients with prophylactic B-Lynch suture developed less PPH and required less intervention with less mean operative blood loss than those who received carbetocin and oxytocin, with nearly similar safety profile. Conclusion B-Lynch suture seems to be more effective in maintaining adequate uterine tone and preventing excessive blood loss in patients with a high risk of developing PPH following cesarean section.