Objective To describe the clinical experience with the B-Lynch technique in the management of postpartum hemorrhage as well as the factors related to the indication of the technique and to present the success rates of the application of the B-Lynch technique. Methods Observational, retrospective, cross-sectional, and analytical study. Patient data was obtained through the study of medical records. The study population comprised of patients who underwent hemostatic suture using the B-Lynch technique, including 104 patients within the period from January 1, 2005, to December 31, 2019. Results Of the total of 104 patients, 82.7% did not present any complications. Blood transfusion and intensive care unit admission were the most prevalent complications, with 13.5% and 15.4%, respectively. Only 1% of the patients had puerperal and surgical site infections. The factors most related to the application of the technique were the presence of previous cesarean section (30.8%), use of oxytocin (16.3%), and preeclampsia (11.6%). Puerperal hysterectomy was performed in 4.8% of the patients due to failure of the method. Conclusion The clinical experience with the B-Lynch technique was satisfactory since it presented few complications, with excellent results in hemorrhagic control. Previous cesarean section, the use of oxytocin, and preeclampsia stood out as factors related to the indication of the application of the technique, and the success rate in controlling postpartum hemorrhage was 95.2%.

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Artigos originaisResumo OBJETIVO: apresentar uma técnica cirúrgica para pacientes submetidas ao parto cesáreo e que evoluem com hemorragia refratária ao uso de medicamentos. MÉTODOS: o critério de seleção das pacientes era falha do tratamento farmacológico no controle da hemorragia pós-parto e o desejo da paciente em preservar o útero. As pacientes foram submetidas ao parto cesáreo e evoluíram com hemorragia pós-parto imediata refratária ao uso de ocitocina, ergometrina e misoprostol. Aplicamos a técnica de sutura descrita por B-Lynch sem modifi cações. Com fi o cromado catgut-2 ou poliglactina-1, transfi xamos o útero em seis pontos, conforme padronização. Após compressão manual do útero realizada pelo assistente, o fi o é tracionado pelas suas extremidades pelo cirurgião e é aplicado um nó duplo seguido de dois nós simples, para em seguida realizar-se a histerorrafi a. RESULTADOS: utilizamos o fi o cromado catgut-2 agulhado em três casos e poliglactina-1 agulhado em um. Nos quatro casos houve parada imediata do sangramento vaginal após aplicação da sutura. Não houve qualquer complicação durante a realização do procedimento e nem no puerpério imediato e tardio das quatro pacientes. CONCLUSÕES: esta técnica representa uma alternativa cirúrgica para o manejo da hemorragia pós-parto. Com sua aplicação relativamente fácil, rápida e segura, pode representar uma redução da morbimortalidade materna em nosso país. AbstractPURPOSE: to present a surgical technique for patients submitted to caesarean section, which evolves to medicine refractory hemorrhage. METHODS: a case report study, of which the including criteria were failure in the pharmacological treatment to control post-partum hemorrhage, and the patients' request to preserve their uterus. Four patients submitted to caesarean section which evolved to immediate post-partum hemorrhage, refractory to the use of ocytocin, ergometrine and misoprostol, were treated with the suture technique described by B-Lynch, without modifi cation. The uterus was transfi xed in six points according to the standard procedure, with chrome catgut-2 or polyglactine-1thread. After the assistant's manual compression of the uterus, the thread was pulled by its extremities by the surgeon, and a double knot followed by two simple knots were applied before performing the hysterorraphy. RESULTS: needled chrome catgut-2 thread was used in three cases and needled poluglactine-1 in one case. In the four cases there was immediate discontinuity of the vaginal bleeding, after the suture. The four patients did not present any complication during the procedure or along the immediate and late puerperal period. CONCLUSION: this technique represents a surgical alternative to deal with post-partum hemorrhage and may represent a reduction in the maternal morbidity and mortality in our country.Hospital Municipal Maternidade Escola Dr. Mário de Moraes Altenfelder Silva -Vila Nova Cachoeirinha -São Paulo (SP), Brasil.

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The National Specialty Commission for Obstetric Emergencies of the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO) endorses to this document. The content production is based on scientific studies on a thematic proposal and the findings presented contribute to clinical practice.