Dr. Sarwat Ara, Associate Professor, Punjab Medical College and Allied Hospital, Faisalabad

ABSTRACT

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 caesarean delivery.
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 2013.
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

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