Ara, Ayesha Khalid, Tasneem Hamid
|Address of Correspondence
Dr. Sarwat Ara, Associate Professor,
Punjab Medical College and Allied Hospital, Faisalabad
Objective: to assess the success and safety of uterine
compression sutures as an alternative to hysterectomy for severe
postpartum hemorrhage (PPH) due to uterine atony at the time of
Study Design: cross sectional study.
Place and Duration: study was carried out in
the department of obstetrics and gynecology, unit 1, Allied Hospital
and PMC Faisalabad.
Duration of study: from January 2010 and December
Methodology: there were total 39534 deliveries
during the study period. Out of which, 1500 patients had PPH more
than 1000ml with an incidence of 3.79%. Eighty eight had severe
to massive PPH who failed to respond to conservative approach.
Fifty two women underwent hysterectomy without having any conservative
surgical management and B-Lynch suture was performed on 36 patients
to control intractable PPH unresponsive to conservative therapy.
Main outcome measures: hysterectomy, immediate post-operative
complications, future menstruations or pregnancy.
Results: in 61.11% (22) the B-Lynch suture was
the only intervention, whereas in 38.88 % (14) it was combined
with uterine vessel ligation. The B-lynch with or without uterine
artery ligation resulted in control of bleeding with uterine preservation
in 83.33% (30) of the women. Hysterectomy was done in 16.66% (6)
cases. Regarding follow up, 33.3 % (10 /30) patients had no complaints
regarding menstruation, 6.66 %( 2/30) women delivered by LSCS
3 years after B-lynch, 10% (3/30) remained ammenorrohic up to
2 years. Hysteroscopic examination of ammenorrohic patients showed
no uterine abnormality in 6.66%( 2) women who later on resolved
spontaneously, while intra uterine adhesions were found in one
woman in whom IUCD was placed and she started having scanty menstruation.
Conclusion: the B-Lynch brace suture is a simple,
safe, rapid and successful procedure.
Keywords: B- Lynch suture, hysterectomy, postpartum
hemorrhage, uterine atony
[Download Complete Original
Format File Size: 61 KB(PDF)
Format File Size: 2.03 MB(PDF)