B-Lynch Suture Research Articles

Early Uterine Necrosis due to Modified B-Lynch Suture.

B-lynch compression sutures, applied as a life-saving procedure in cases of atonic postpartum haemorrhage can sometimes lead to life-threatening complications. We report a case of early uterine necrosis following B-lynch compression suture application for PPH at the time of LSCS, resulting in peripartum hysterectomy.

Ovarian necrosis of both ovaries with uterine ischemic changes following B-Lynch sutures: A rare complication and review of literature

Ovarian necrosis of both ovaries with uterine ischemic changes following B-Lynch sutures: A rare complication and review of literature

B-Lynch Suture, Uterine Arterial Ligation and Foley Catheter Application as Fertility Sparing Treatment in Postpartum Atony

B-Lynch Suture, Uterine Arterial Ligation and Foley Catheter Application as Fertility Sparing Treatment in Postpartum Atony

Uterine torsion in a 25-week pregnant female with congenital uterine didelphys and intraoperative complication of uterine atony: a report of a rare clinical case

Uterine torsion is an extremely rare pregnancy-related complication. Its diagnosis is often difficult due to unspecific clinical symptoms, which can be mistaken for other conditions such as placental abruption. A 23-year-old pregnant woman with gestational age of 25 weeks presented with acute abdominal pain and hypertonic uterus. Vaginal examination revealed a septated vagina, double cervix, and double uterus. Bedside sonography revealed absence of fetal cardiac activity and signs of placental abruption. The patient was emergently operated with a preliminary diagnosis of severe placental abruption in the uterus didelphys. During surgery, we noted a double uterus and the fetus had implanted in the right uterus, which was twisted 180 degrees to the left. After detorsion, a low transverse hysterotomy was performed to extract the dead fetus. However, subsequently, the patient developed uterine atony. Subtotal hysterectomy and right adnexectomy were inevitable due to failure of conservative treatment with B-lynch suture. The patient’s postoperative condition was stable, and she was discharged after 5 days.

Uterine Sandwich Suture: The Concept of “Role Sharing” Is Important

Uterine compression suture and intrauterine hemostatic balloon are important procedures to achieve hemostasis for obstetric hemorrhage. A combined use of these two, with B-Lynch suture + Bakri balloon being the most often employed ones, is referred to as a “uterine sandwich”, which is an effective hemostatic procedure. Fundamentally, the former and latter stop bleeding from the uterine body and lower uterine segment, respectively. This represents the concept of “role sharing” for hemostasis. Recognizing this concept is of practical importance.

Características clínicas de gestantes en trabajo de parto con infección SARSCoV- 2 en la altura: serie de casos

Introducción. A gran altitud, se ha observado menos casos y menos letalidad de COVID-19 en comparación con cifras reportadas a nivel del mar. Actualmente no hay publicaciones que informen el comportamiento clínico de COVID-19 en mujeres embarazadas adaptadas a la altura e hipoxia crónica en el Perú. Métodos. Estudio retrospectivo mediante revisión de historias clínicas del 6 de marzo de 2020 al 15 de junio de 2020. Se describe los primeros trece casos de gestantes con COVID-19 atendidos en el Hospital COVID-19 Simón Bolívar, ubicado a 2 750 msnm. Los casos procedían de altitudes entre 2 035 msnm y 3 502 msnm. El análisis estadístico se realizó con SPSS, versión 19.0. Resultados. Trece casos de gestantes con COVID-19 confirmado por IgM para SARS-CoV-2, fueron tratadas a 2 750 msnm (9 022,31 pies), en los Andes peruanos. El parto fue por cesárea en ocho casos (61,5%) y por vía vaginal en cinco (38,5%). Hubo dos casos (15,4%) de preeclampsia, uno de ellos diagnosticado como síndrome HELLP, prematuridad y muerte fetal. Tres casos (23,1%) desarrollaron hipotonía uterina posparto y requirieron sutura de Hayman o B-Lynch. Dos casos (15,4%) se complicaron con oligohidramnios y otros dos casos con infección urinaria. Los niveles de hemoglobina variaron entre 11,1 y 16 g/dL. Solo un caso (7,7%) presentó sintomatología, con dolor faríngeo leve. No se observó transmisión vertical detectada por IgM/IgG para SARS-CoV-2. La evolución clínica fue favorable en los trece casos y el alta fue a los 2 a 4 días, para continuar la cuarentena en domicilio. Conclusiones. En el presente estudio preliminar, las gestantes en trabajo de parto con COVID-19 por prueba rápida IgM para SARS-CoV-2 en la altura fueron generalmente asintomáticas; no hubo transmisión vertical. Se presentó alto porcentaje de otras complicaciones obstétricas.

Uterine Compression Suture Versus Cesarean Hysterectomy in Management of Intractable Postpartum Hemorrhage

Background: Postpartum hemorrhage (PPH) is the third leading cause of maternal death. Uterine atony is the most common cause, and surgical management is the last method for PPH. Objective: To assess operative outcomes after uterine compression suture (B-Lynch suture technique) versus cesarean hysterectomy. Materials and Methods: The comparison retrospective research evaluated the operative outcomes of the pregnant women managed by the B-Lynch suture technique (group 1) versus cesarean hysterectomy (group 2). Unique data form, designed to collect all patients involved in the present study, were reviewed and analyzed. The population study was pregnant women divided into two groups. Thirty-five patients were assigned to group 1 and thirty-five patients were assigned to group 2. The independent t-test was used to compare means of categorical variables between the two groups, with p<0.05 indicating statistical significance. Results: Twenty-three thousand two hundred fifty-eight pregnant women delivered during the study period, which was 18 years 6 months. PPH occurred in 563 patients (2.42%), in both vaginal and cesarean deliveries. Intractable PPH occurred in 177 patients (0.76%) during cesarean section. Clinical data risk factors were age, complications while receiving blood transfusion, injury to the urinary bladder, and death. Several outcomes in group 1 were better than in group 2, such as the interval of operation, blood loss, fever after surgery, and saving of life. However, three patients in the trial of B-Lynch suture were changed to hysterectomy due to curative management. Conclusion: The uterine compression suture (the B-Lynch technique) should be used promptly to manage acute PPH due to uterine atony. Additionally, a cesarean hysterectomy might be used for surgical management in the latter method, depending on the severity of the patient, the etiology of PPH, and the obstetrician’s skills and experience. Keywords: Postpartum hemorrhage, Uterine compression suture, Cesarean hysterectomy

Uterine compression sutures with additional hemostatic procedures for the management of postpartum hemorrhage.

The aim of the study was to evaluate the efficacies and possible short-term complications in women receiving uterine compression sutures only and those with additional hemostatic procedures for the management of postpartum hemorrhage. It was a retrospective study carried out from year 2009 to 2019 at a tertiary obstetric hospital and included 79 women who underwent uterine compression sutures (B-Lynch sutures, Hayman's sutures and Cho's sutures) for primary postpartum hemorrhage. Thirty-six of these women had additional hemostatic procedures (uterine artery ligation or embolization) performed for bleeding control. Of the 43 women who were primarily treated with uterine compression sutures only, the success rate to preserve the uterus was 97.7% (42/43). In women with uterine compression sutures and additional hemostatic procedures performed, the success rate was 75% (27/36). Among these two groups of women without peripartum hysterectomy, there were no significant differences in the incidence of secondary postpartum hemorrhage (14.8% vs. 11.9%; P = 0.729), postoperative endometritis (14.8% vs. 14.3%; P > 0.99) and retained products of conception (3.7% vs. 9.5%; P = 0.641) during their 6-week postpartum checkup. Three women were diagnosed to have hematometra. No pyometra or uterine necrosis was noted. Uterine compression sutures with additional hemostatic procedures are effective to control postpartum hemorrhage and prevent hysterectomy. The short-term complication rate is low. Long-term monitoring is needed to identify rare but potentially dangerous complications.

Carbetocin Or Oxytocin To Prevent Postpartum Haemorrhage Due To Uterine Aony In Cases Of Elective Caesarean Section


 
 
 Background: Despite the technological advancement made in the past few decades, postpartum haemorrhage (PPH) remains one of the principal causes of maternal deaths in developing nations. The administration of uterotonic drugs widely prevents the PPH; therefore, it is the main point of active management. Among uterotonics, oxytocin has proven to be very effective in reducing the incidence of PPH. One prophylactic drug which has been introduced in recent times is carbetocin, a synthetic long-acting oxytocin analogue. It has a longer half life of 41 min, allowing it to stimulate a prolonged uterine response of up to an hour after a single intravenous dose, obviating the need for infusion.
 Methods: A total of 120 pregnant women divided into two groups; Group I (Carbetocin group) included 60 women who received carbetocin and delivered by caesarean section (CS), Group II (Oxytocin group) included 60 women who received oxytocin and delivered by caesarean section (CS).
 Results: Our result showed that, there was a statistically significant difference for the prevention of atonic postpartum hemorrhage between the two groups (p<0.01), for carbetocin group. There was also a statistically significant difference between the two groups (p < 0.01), according to need to additional procedures, such as need to modified B-lynch sutures and need to bilateral uterine arteries ligation for carbetocin group.
 
 
 
 Conclusion: We concluded that carbetocin was a better alternative to traditional oxytocin in the prevention of PPH after elective caesarean section.
 
 
 
 
 

COMOC-MG Stitch: Modification of B-Lynch Suturing Technique to Control Atonic Post-partum Haemorrhage.

The COMOC-MG (Compression Of Myometrium and OCclusion of uterine artery by Dr. Mahesh Gupta), a modified B-Lynch stitch technique, utilized polyglycolic acid double strand suture with 80mm long straight taper point and 50mm half circle round bodied needle. Its dual action of causing hemostatic compression as well as reduced uterine blood flow, in managing PPH is exemplified using 3 cases. The COMOC-MG stitch technique was found to be effective, with fewer complications, in controlling post-partum haemorrhage (PPH). One subsequent full-term pregnancy occurred after 6 years of this surgery. The COMOC-MG stitch technique is a valuable and safe alternative to B-Lynch or other modified B-Lynch suturing techniques for successful management of atonic PPH, while preserving fertility.

Mechanical and surgical interventions for treating primary postpartum haemorrhage.

Mechanical and surgical interventions for treating primary postpartum haemorrhage.

A prospective study of B-Lynch suture in the management of atonic PPH at tertiary care centre

Postpartum haemorrhage (PPH) is one of the leading causes of maternal mortality and morbidity especially in the developing countries like India. Uterine compression sutures, originally described by B-Lynch et al can successfully control life-threatening PPH. With this background, we studied the use of modified B-Lynch sutures in our setup.It was a single centre, hospital based cross sectional study conducted in the department of obstetrics and gynaecology in a tertiary care hospital in Maharashtra. About 50 cases during the study period (Nov 2017 to June 2019) who failed the medical management of control of PPH were included in the study. Demographic details like age, gestational age, religion, socio economic status and gravid were noted in the case record form. Amount of blood loss, success rates, immediate complications and follow up fertility were assessed.Among the 50 study subjects, 24% had blood loss of <1000ml, 54% had loss between 1000 to 1500ml, 16% had loss of 1501 to 2000ml and 6% had loss more than 2000ml in the present study. About 80% of the cases were successful and 20% failed in the present study. About 6% of the cases had wound gaping, 12% each had fever and had hospital stay more than 5 days and 14% of the cases had wound infection in the present study. About 90% of the cases had return of regular menstruation in the present study.The success rate of B Lynch suture was 80% in the present study. There were few post operative immediate complications in our study. Follow up data also suggested that majority of them recovered with normal routine. In our experience, the B-Lynch technique is a safe, effective and easily implemented method of arresting bleeding in cases of major primary PPH due to uterine atony.

The efficacy between cervical-lifting suture and lower B-Lynch suture in placenta previa: a retrospective cohort-study.

This study is performed to evaluate and compare the efficacy of cervical-lifting suture and lower B-Lynch suture in different severity of placenta previa associated with lower uterine segment bleeding. We evaluated the effectiveness of cervical-lifting suture (n = 51) and lower B-Lynch suture (n = 137) in stopping the bleeding from lower uterine segment. Additionally, we used different statistical methods, including overall analysis, subgroup analysis and approximate randomization analysis, to evaluate the efficacy of the two assessments. The medical records of these 188 participants were extracted and all of the patients were followed up for six weeks. The majority of patients were multipara and complicated with previous cesarean delivery and abnormal adherent placenta. The median intraoperative blood loss and the median amount of red blood cell transfusion were lower in the cervical-lifting suture group in comparison to the lower B-Lynch suture group. Our study provides evidence that cervical-lifting suture has less intraoperative blood loss and red blood cell transfusion for controlling lower uterine segment bleeding in placenta previa.

Determinants of cesarean-related complications: high number of repeat cesarean, operation type or placental pathologies?

Background Cesarean delivery (CD) is one of the most common operations worldwide. Vaginal birth after cesarean (VBAC) could be a solution to decrease increased CD rates. On the other hand, risks of VBAC on maternal and neonatal outcomes drifts physicians and patients to a scheduled CD. Successive CDs, especially after the 3rd operation, increase complications for the fetus and the mother. Operation type (emergency or elective CD) could be a risk factor of increased morbidities, like placental implantation anomalies. Evaluation of these conditions related to complications and morbidities were investigated. Material and methods: Women who underwent the fourth and more repeat CD in Bursa Yuksek Ihtisas Training Research Hospital between March 2016 and December 2019 were retrospectively reviewed. Pre-operative characteristics, per-operative and post-operative complications were reviewed. Patients were separated into groups as operational type, repeat cesarean number, and major morbidities. A comparison between groups was evaluated. Results: A total of 46.048 women gave birth, of which 17,721 underwent CDs with a rate of 38%. The rate of primary CD was 18%. The number of the fourth or more CD performed was 854. The number of patients who underwent fourth and fifth or more CD and of these operational data could be accessed was 599 and 145, respectively. The overall complications were detected as severe adhesions (n: 220), preterm delivery (n: 91), stillbirth (n: 9), admission to NICU (n: 98), bladder injury (n: 10), uterine scar dehiscence (n: 6), uterine rupture (n: 6), uterine atony (n: 26), blood transfusion requirement (n: 68), preterm delivery (n: 91), placenta previa totalis (n: 24), morbidly adherent placenta (n: 14), hysterectomy (n: 12), partial uterine resection (n: 2), uterus-conserving interventions (n: 26). The number of patients with major morbidity was 105. Emergency cesarean performed in 339 of 744 patients. A comparison of the emergency cesarean group with elective repeat cesarean group revealed no significant difference in operative adverse outcomes. Comparing patients between 4th repeat CD with 5th and more CD revealed a significant difference in severe adhesion, morbidly adherent placenta and hysterectomy. Previa totalis were detected in 24 patients. All of them experienced major morbidity with 12 of them underwent hysterectomy. The rest of them performed Uterus-conserving treatments (B-Lynch Suture, Bacri Balloon, Hypogastric artery ligation ) and a total of 51 units of packed red blood cells and 32 units of Fresh Frozen Plasma were transfused to 9 (37%) of 24 patients. Conclusion: The major risk factor of the morbidity is placenta previa whose incidence has dramatically increased after 3rd cesarean. Emergency cesarean did not increase the complication rate in the present study. Fourth and more repeat CDs ought to be performed by experienced obstetricians in high-equipped tertiary hospitals.

Bimanual examination for clot evacuation: a retrospective cohort study of women with postpartum haemorrhage after vaginal delivery

BackgroundBimanual clot evacuation (BCE) is a simple clinical manoeuvre that may reduce need for surgical intervention in the management of severe postpartum haemorrhage (PPH). We sought to determine whether performing BCE in cases of severe PPH after vaginal birth reduces the need for surgical intervention.MethodsA retrospective chart review of women who delivered vaginally with a severe PPH between January 1, 2011 and December 31, 2014 in a single tertiary women’s hospital in Sydney, Australia was conducted. Severe PPH was classified as a blood loss ≥1000mls. The need for surgical management (including operating theatre uterine exploration or evacuation, intrauterine balloon tamponade, repair of significant trauma, uterine or internal iliac artery ligation, B-Lynch suture insertion or hysterectomy) was the primary outcome measure, as expressed by need for operating theatre utilisation.ResultsFrom a cohort of 438, 149 women (34.0%) had BCE, of whom 29 (19.5%) required surgical management compared to 103 of 289 women with no BCE (35.6%); an odds ratio (OR) of 0.38 for BCE (confidence interval 0.20–0.72; p = 0.003). Early BCE (< 1 h of delivery) was associated with a further reduction in surgery (OR 0.24; confidence interval 0.08–0.70; p = 0.009) compared to late BCE (> 1 h of delivery). There was no reduction in estimated blood loss (p = 0.86) or blood transfusion (p = 0.71) with BCE.ConclusionOur study suggests BCE reduces theatre utilisation in the context of severe PPH following vaginal delivery. Prospective trials are needed to determine whether BCE should be endorsed as a treatment modality for PPH post-vaginal delivery.

Effectiveness of B-lynch suture technique for treatment of high risk women for postpartum haemorrhage at Liaquat Medical University Hospital Hyderabad.

Postpartum haemorrhage (PPH) is an incident in pregnant women and due to this reason women are delivered by vaginally or cesarean section. Globally most of the women die due to this significant reason. Several methods are being used to prevent hysterectomy when “uterotonic” drugs are fail in the management of postpartum haemorrhage. Objectives: To determine the effectiveness of B-lynch suture technique for treatment of high risk women with postpartum haemorrhage at Liaquat medical University Hospital Hyderabad. Study Design: Descriptive cases series. Setting: Department of the obstetric/Gynaecolgoy at Liaquat University hospital Hyderabad. Period: 6 months from 1st January to 30th June 2018. Material &amp; Methods: There were fifty patients who were found high risk for PPH on history and clinical examination was included in this study. A detailed medical history and base line equitable investigation was done. They were operated irrespective of the surgical procedure by which B-Lynch suture technique was applied. Effectiveness was noted and all other data was entered on predesigned proforma attached with. Results: The average age of the patients was 31.54±6.54 years and Average blood loss the PPH patients were 931.38±32.994 ml. Effectiveness of B-lynch suture technique for treatment of high risk women with postpartum haemorrhage was 88% as presented. Conclusion: In this study we found that “B-Lynch suture” technique is safe and effective for the management of postpartum hemorrhage.

CASE REPORT OF PLACENTA ACCRETA: SUCCESSFUL MANAGEMENT WITH CONSERVATIVE SURGERY

The incidence of placenta accreta spectrum (PAS) disorders has increased over the last decades due to increase in cesarean deliveries, resulting in increase in cesarean hysterectomies , maternal mortality and morbidity but since last few years there has been a gradual shift towards the idea of conservative management. Conservative management of PAS is known to reduce major obstetric hemorrhage and salvage hysterectomy. We present a case of placenta accreta diagnosed by ultrasound where management of post-partum hemorrhage was accomplished by conservative surgery. The concise steps taken in management of placenta accreta before and during cesarean section were: Availability of 4 donors with cross match; Stark cesarean section; atraumatic clamps around uterine arteries; ureterotonic drugs; external (B-Lynch suture); and application of diathermy where required. This experience indicates that few selected cases of PAS could be managed conservatively who are at risk of intra-partum hemorrhage and post-partum hemorrhage.

Nécrose utérine suite à une combinaison de compressions utérines et de ligature vasculaire lors d'une hémorragie post-partum: rapport de cas

L'hémorragie de délivrance reste la première cause de mortalité maternelle au Maroc, c´est une urgence obstétricale qui nécessite une prise en charge rapide, efficace et multidisciplinaire. Dans les cas d´hémorragie du post-partum grave rebelle au traitement médical, les progrès de la radiologie interventionnelle et surtout des techniques chirurgicales ont fourni des alternatives sûres et efficaces à l'hystérectomie d´hémostase. On rapporte un cas de nécrose utérine suite à un traitement conservateur chirurgicale de l´hémorragie de délivrance à base d´une combinaison de technique de compression utérine type B-Lynch et triple ligature vasculaire de Tsirulnikov. La patiente a présenté un tableau de sepsis a J4 du post-partum avec un état fébrile et des douleurs pelviennes et un syndrome inflammatoire biologique qui s´est aggravé 48 heures après par l´apparition de contracture abdominale. Le scanner abdomino-pelvien a montré des bulles de gaz dans le myomètre utérin évoquant une nécrose. Une laparotomie exploratoire a été réalisée, l'exploration a révélé une nécrose complète de l'utérus. Les techniques chirurgicales des sutures de compression utérine jouent un rôle majeur dans l'arsenal thérapeutique de l'hémorragie post-partum pendant la césarienne. Elle permet, en complément ou en alternative à la ligature vasculaire, la préservation de la fertilité de la patiente mais elle nécessite également une prudence et une surveillance maximale des complications dont la plus grave est la nécrose utérine.

Conservative surgical management for immediate postpartum hemorrhage

Abstract Background Conservative surgical management for postpartum hemorrhage (PPH), such as balloon tamponade, uterine compression suture, and uterine artery ligation, has the benefit of preserving reproductive function. Objectives To assess the efficacy and subsequent pregnancy outcome of conservative surgical management for patients with immediate PPH. Methods Medical records of patients who had PPH between January 2011 and December 2016 were reviewed. Conservative surgical management included B-Lynch uterine compression suture, Bakri balloon tamponade, and uterine artery ligation. The treatments were considered successful if patients did not require subsequent hysterectomy. Perioperative complications and subsequent pregnancy outcomes were recorded. Results Of 30,271 deliveries, 669 patients experienced PPH or 2.2% of total deliveries. Sixty-one patients (9.1%) did not respond to medical treatment with various uterotonic agents. Hysterectomy was selected initially in 30 patients. Conservative surgical management was performed in 31 patients: 15 Bakri balloon tamponade, 13 uterine compression suture, and 3 uterine artery ligation. There were 3 patients who failed Bakri balloon tamponade and proceeded to perform uterine compression suture with successful outcome. The success rates for conservative surgical treatment were 66.7%, 75%, and 66.7%, respectively. All patients who had successful conservative surgical management resumed normal menstruation. Three out of 11 patients (27.3%) who desired subsequent pregnancy were able to conceive and carry out a viable pregnancy. Conclusion Conservative surgical management has acceptable success rates for controlling intractable immediate PPH. Implementation of such procedures should be done to preserve fertility and decrease maternal morbidity and mortality.

Emergency Peripartum Hysterectomy

Uterine atony is a major cause of postpartum hemorrhage (PPH), an emergency event that remains one of the leading causes of maternal morbidity and mortality worldwide. This study reviews a case of severe atonic PPH after a primary cesarean, which resulted in an emergency peripartum hysterectomy. In the United States, prevalence studies have revealed a peripartum hysterectomy rate of almost 1 per 1,000 births. Multidisciplinary collaboration using effective communication is needed when responding to the severity of Stage 3 PPH. A 28-year-old woman, gravida 3 para 0, at 40.0-weeks gestation arrived at the labor and delivery unit in active labor. During labor, she received oxytocin augmentation and an epidural. Cervical dilation progressed slowly, with the patient remaining at 9.5 cm for 5 hr. On complete dilation, the patient pushed for 1.5 hr before the decision was made to proceed with a cesarean due to failure of the fetus to descend and maternal exhaustion. After the successful birth of a 4,042-g newborn by cesarean, persistent uterine atony developed. Interventions were then enacted, guided by the California Maternal Quality Care Collaborative Obstetric Emergency Management Plan. Additional staff arrived in operating room to provide support. Multidisciplinary teamwork was achieved through use of effective communication techniques, including situation–background–assessment–recommendation and closed-loop communication. Pharmacologic interventions included the use of oxytocin, misoprostol, methylergometrine maleate (×2), and carboprost tromethamine (×2). Procedural interventions by the physician included bimanual uterine massage, uterine packing, B-Lynch suture, and intrauterine balloon tamponade. Maternal hypotension and tachycardia developed, leading to the initiation of the massive transfusion guidelines. Despite interventions, severe uterine atony and brisk vaginal bleeding continued, resulting in a total quantitative blood loss of 4 L. The decision was made to proceed with an emergency peripartum hysterectomy. Postpartum emotional support was provided by a multidisciplinary team that included nursing, physician, chaplain, and social services. The mother and her newborn were discharged home on Postoperative Day 4. This case study demonstrates the success of quickly initiated PPH protocol interventions that are necessary to prevent maternal mortality and knowing the current literature on risk identification, management, and treatment of severe PPH.