The B-Lynch suturing technique (brace suture) may be particularly useful because of its simplicity of application, life saving potential, relative safety, and its capacity for preserving the uterus and thus fertility. Satisfactory haemostasis can be assessed immediately after application. If it fails, which has not yet been the case, other more radical surgical methods as mentioned in this paper and in the literature can be considered. The special advantage of this innovative technique is an alternative to major surgical procedures to control pelvic arterial pulse pressure or hysterectomy. This suturing technique has been successfully applied with no problems to date and no apparent complications.Postpartum haemorrhage is a serious obstetric problem. Life threatening postpartum haemorrhage can be a nightmare. Current clinical methods are unsuitable for the objective assessment of postpartum haemorrhage, and each patient's ability to compensate varies considerably. There are no reliable data on the true incidence of severe life threatening postpartum haemorrhage. The morbidity and mortality rise not only with delay in diagnosis and treatment but also in accordance with any increase in caesarean section rate. Available methods to control postpartum haemorrhage depend on the cause but in general delaying diagnosis and treatment may lead to a life threatening situation. Five percent of vaginal deliveries may lead to postpartum haemorrhage with a blood loss > 1 L3. The common causes include uterine atony, lower genital tract lacerations, retained placenta and placental fragments, coagulopathy, uterine inversion and ruptured uterus9. These causes can individually or collectively lead to life threatening situations.Published data suggest a variety of acceptable methods of treatment such as simple bi-manual compression, ecbolics such as oxytocins, syntometrine and prostaglandins which are safe and effective but occasionally prove inadequate or unsatisfactory. Surgical methods vary depending on the site of bleeding, the severity of the condition and the cardiovascular stability of the patient. Various surgical methods to reduce pelvic pulse pressure have been described, from simple surgical ligature of the uterine artery to more complicated uterine, ovarian and internal iliac artery ligature3*'. These procedures need skill which may not normally be possessed by the duty Registrar faced with such problems in the middle of the night. Probably some Consultants have never done such complicated procedures because of the relative rarity of this emergency obstetric problem.We describe an innovative method which is simple and effective, tried and tested with a successful outcome for the control of life threatening postpartum haemorrhage, as an alternative to more complicated surgery including hysterectomy. Description of techniqueThe following steps are involved in the competent application of the B-Lynch suturing technique:1. The patient under general anaesthesia is catheterised and placed in the Lloyd Davies position for acces...

The different uterine suture techniques have proved to be valuable and safe alternatives to hysterectomy in the control of massive PPH, and the present review can make the surgeon better aware of their effective use and the risks they may entail.

Postpartum haemorrhage (PPH) is a worldwide problem. The historical background dates back to William Smelley's in the seventeenth century in his famous treaty of the theory and practice of midwifery in 1752. Changes in clinical factors and surgical expertise compel the modern day midwife and obstetrician to be vigilant in identifying risk factors and apply appropriate solution early. The recent confidential enquiry into maternal death (why mothers die (2000-2002)) identifies areas of substandard care. The rising caesarean section rate adds to the rising incidence of PPH. The reduction in junior doctor's hours may limit the pool of experienced obstetric surgeons available to manage severe PPH competently. There can be major complications following radical surgery for PPH. These include loss of fertility, other morbidity and even maternal death. The invention of the B-Lynch surgical technique for the conservative management of PPH was first performed and reported by a consultant obstetrician and gynaecological surgeon in Milton Keynes NHS Trust publishing the first series of cases in BJOG 1997. This has made a significant impact on the conservative surgical management of massive PPH. There are now over 1300 successful applications of this technique worldwide (CB-Lynch personal communication). Other similar or modified techniques such as Cho's Square Suture and Haymen's modification of the B-Lynch Suture Technique have been introduced adding to more available methods of conservative surgery. The current list of publications of successful application of the B-Lynch compression technique is encouraging and more outcome data can be reported by a letter or e-mail to enquiries@cblynch.com. Obstetricians and midwives both in developed and underdeveloped countries should seek training and attend fire drills in PPH control to avoid maternal morbidity and death. There should be special concentration on effective conservative surgery such as uterine compression techniques to avoid major morbidity and loss of fertility.

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