Surgical treatment of uterine atony employing the B-Lynch technique

Postpartum hemorrhage remains a major cause of maternal morbidity and mortality. Four cases utilizing the B-Lynch technique for control of hemorrhage secondary to uterine atony are presented. The B-Lynch technique appears to be effective in controlling postpartum hemorrhage. More experience is needed before the B-Lynch technique can be accepted as routine practice.     

Surgical treatment of uterine atony employing the B-Lynch technique

Postpartum hemorrhage remains a major cause of maternal morbidity and mortality. Four cases utilizing the B-Lynch technique for control of hemorrhage secondary to uterine atony are presented. The B-Lynch technique appears to be effective in controlling postpartum hemorrhage. More experience is needed before the B-Lynch technique can be accepted as routine practice.     

Uterine compression sutures for post-partum bleeding with atony; modification of the B-Lynch suture

We have described a modification of the B-Lynch uterine compression suture which is simple and effective. This technique apposes the anterior and posterior uterine walls, obliterating the cavity and thereby provides effective control of post-partum haemorrhage as a result of uterine atony. It comprises of vertical compression sutures and is distinct from B-Lynch and Haymen's suture by having an additional firm puncture just below the uterine fundus. This means that the suture is transfixed at the uterine fundus, thus eliminating the risk of the sutures sliding off at the uterine fundus.     

The Bolbos technique for the management of uncontrollable intra-caesarean uterine bleeding

Objective We describe a new conservative surgical technique for the management of intra-operative post-caesarean bleeding.Methods This technique involves the application of ligation sutures to the main branches of the right and left uterine arteries at the level of the lower segment transverse uterine incision and a constriction suture to the lower segment of the posterior uterine wall.Results We have used this method in nine cases and it was effective in controlling the bleeding in eight, thus avoiding the need for a more extensive procedure.Conclusion If medical management fails to control intra-operative post-caesarean bleeding, conservative surgery or even a caesarean hysterectomy may be required. Our technique is presented as a safe, simple, effective and readily reproducible alternative. Also, its effectiveness can be promptly assessed and if the bleeding persists, another, more complex procedure can be performed.     

Uterine compression sutures for postpartum bleeding with uterine atony

Objective  To assess the efficacy of a new uterine compression suturing technique in reducing postpartum haemorrhage secondary to severe uterine atony.
Design  Retrospective study.
Setting  University hospital between December 2000 and March 2006.
Population  Twenty women with uterine atony and postpartum bleeding that did not react to usual medical management.
Methods  All these women underwent compression suturing of the uterus, in which the anterior and posterior walls of the uterus were attached so as to compress the uterus.
Main outcome measures  Arrest of the bleeding, complications and fertility.
Results  Uterine compression suturing was sufficient to stop the bleeding immediately in 95% of the women. None of the women developed complications related to the procedure. All the women recovered normal menstrual cycles. Since uterine compression suturing, eight women have tried to conceive and six (75%) have had a term delivery.
Conclusion  Uterine compression suturing is a simple conservative procedure to stop postpartum haemorrhage in the case of failure of the usual management. This surgical technique can be performed quickly and does not seem to decrease fertility.     

The impact of Bakri balloon tamponade on the rate of postpartum hysterectomy for uterine atony

Objective: Our objective was to evaluate the impact of uterine tamponade with a Bakri balloon on the rate of postpartum hysterectomy due to uterine atony.

Methods: We performed a retrospective cohort study of all deliveries >20 weeks gestation from January 2002 to March 2013 at Baystate Medical Center. Charts were reviewed to determine incidence of postpartum hysterectomy, Bakri balloon placement, uterine artery embolization (UAE) and the B-Lynch procedure. Patients with evidence of placenta accreta were excluded. The primary outcome was the change in rates of postpartum hysterectomy for uterine atony before and after the introduction of Bakri balloon tamponade, using chi-square testing.

Results: There were 48?767 deliveries during the study period, with 17?950 before and 30?817 after the introduction of the Bakri balloon. A total of 43 Bakri balloons were placed during the study period and 21 hysterectomies were performed for postpartum hemorrhage secondary to uterine atony, 14 before and 7 after the introduction of the Bakri balloon. This was consistent with a decrease in the rate of postpartum hysterectomy from 7.8/10 000 deliveries to 2.3/10 000 deliveries (p?=?0.01).

Conclusion: Our findings show that utilization of the Bakri balloon is associated with a decreased rate of postpartum hysterectomy.     

A new uterine compression suture for postpartum haemorrhage with atony

Postpartum haemorrhage (PPH) is a major cause of worldwide maternal mortality and is still associated with significant morbidity. After the B-Lynch suture was reported in 1997, several different uterine compression sutures were found to be successful in controlling PPH. In this paper, we describe another simple variation of the uterine compression suture technique, which was performed without an incision in the uterine wall, without entering the uterine cavity and without suturing the anterior and posterior walls of the uterus together, so minimising the trauma to the uterus. This new uterine compression suture is an effective and safe surgical treatment for PPH caused by atony. It has the potential to apply to intractable PPH after vaginal delivery.     

The B-Lynch technique for postpartum haemorrhage: an option for every gynaecologist

OBJECTIVE: The aim of this study is to evaluate the clinical and sonographic predictors of ultimate successful vaginal delivery in women undergoing external cephalic version. STUDY DESIGN: The study population consisted of women with external cephalic version performed at or after 36 weeks of gestation. They were randomized into group A or B, each consisted of half of the total study population. Logistic regression was performed on group A to identify the significant independent variables in predicting successful cephalic vaginal delivery, which were used to construct a prediction model. The derived regression model was then tested in group B to assess its accuracy. RESULTS: The study included 407 pregnancies. Maternal weight (kg) at the time of version, maternal height (cm), multiparity, engagement of fetal presenting part, and fetal head palpable were significant independent variables of successful version and vaginal delivery (regression coefficients are: -0.084, 0.085, 1.752, -1.271, and 0.725, respectively). A prediction model was constructed based on these independent variables. The weighted average of the overall accuracy in predicting success or failure of version and vaginal delivery was 70.9%. The regression model was then applied to study group B. Using 0.50 as the cutoff value, the sensitivity, specificity, positive, and negative predictive values were 75.4, 58.8, 73.7, and 61.0%, respectively. CONCLUSION: A regression model constructed based on clinical variables failed to provide an accurate predictive tool of successful external cephalic version and vaginal delivery. However, in women who are equivocal about external cephalic version, a high prediction of success would be encouraging.     

B lynch suture for post partum heamorrhage due to uterine atony

Uterine atony and concomittant massive haemorrhage is one of the most dangerous complications of labour. Conventional, conservative treatment approach comprising of oxytocics such as oxytocin, methergin or prostaglandins may fail in some cases, mandating surgical techniques, including hysterectomy. B Lynch compression uterine suture may be a safe and effective method of treatment in post partum heamorrhage and in most of cases may replace more complicated techniques. In this article, together with referring the technical aspects of this procedure, we present a case of successful treatment.     

Single square hemostatic suture for postpartum hemorrhage secondary to uterine atony

Objective

The objective of this study is to describe a novel technique for the treatment of postpartum hemorrhage and evaluate its effectiveness and safety.

Methods

Single square hemostatic suture was performed for uterine atony when postpartum hemorrhage did not respond to medical therapy and bilateral uterine artery ligation. We retrospectively reviewed the data of 11 women and evaluated their endometrial cavity with hydrosonography after a follow-up period of 8–34 months.

Results

The single square hemostatic suture successfully stopped bleeding in all of the cases. Of the 11 women, 2 could not be traced. Menstruation started without delay in nine women. One of the women achieved pregnancy 25 months after surgery. The six women who underwent hydrosonography had an intact endometrial cavity.

Conclusions

For women who desire future fertility, and when bilateral uterine artery ligation is not sufficient to control PPH, single square suturing may be used as an effective and safe procedure.     

Ten year follow-up of the effect of the B-Lynch uterine compression suture for massive postpartum hemorrhage

The B-Lynch surgical technique for the management of massive postpartum hemorrhage (PPH) has been used successfully since 1989 in cases where bleeding was secondary to uterine atony with failed conservative management. It allows for conservation of the uterus for subsequent menstrual function and pregnancies. In this report, we present a follow up of a case with successful pregnancy ten years after PPH was managed with the B-Lynch uterine compression suture to demonstrate the long-term anatomical consequences of this operation. This case represents the longest follow up after the application of the B-Lynch suture (brace suture) technique for the control of massive PPH as an alternative to hysterectomy. Published data have confirmed that on the balance of probability, the B-Lynch surgical technique is safe, effective and free of short- and long-term complication.