Fertility after B-Lynch suture and stepwise uterine devascularization

Sentilhes, Loïc; Gromez, Alexis; Trichot, C.; Ricbourg-Schneider, Aude; Descamps, Philippe; Marpeau, L.

doi:10.1016/j.fertnstert.2008.09.082

Cited by 53 publications

(45 citation statements)

References 17 publications

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“…8 Primary long-term studies suggest that uterine-sparing surgical procedures do not appear to impair subsequent fertility and pregnancy outcomes. [7][8][9][10] Previous studies of women undergoing embolisation have suggested that it does not impair subsequent fertility, [11][12][13][14][15][16][17][18][19][20][21][22][23][24] but the cohort, methodology and follow-up rate of these small case series are limited. 25 Moreover, in the majority of case series, no information is available regarding women with presumed preserved fertility and desire for pregnancy who do not become pregnant.…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, multiple uterine devascularisation procedures may increase the risk of subsequent ischaemic complications of synechia and/or impair the subsequent fertility and pregnancy outcomes, rendering this strategy unwarranted. 8,10 The primary objective of this study was to determine the impact on fertility and pregnancy outcomes of embolisation for severe PPH based on a large single-centre cohort. The secondary objectives were to compare maternal longterm outcomes between women undergoing embolisation versus both embolisation and a uterine-sparing surgical procedure, and to attempt to identify specific risk factors associated with an increased likelihood of intrauterine synechia.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage

Sentilhes

Gromez

Clavier

et al. 2009

BJOG

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Objectives To determine and compare the fertility and pregnancy outcomes following embolisation with or without uterine-sparing surgery for postpartum haemorrhage, and to attempt to identify specific risk factors associated with an increased likelihood of intrauterine synechia.Design Retrospective study.Setting University-affiliated tertiary referral centre.Population All consecutive women who had an embolisation with or without uterine-sparing surgery (vessel ligation and/or uterine compression) for postpartum haemorrhage between 1994 and 2007 were included.Methods Data were retrieved from medical files and telephone interviews.Main outcome measure(s) Fertility and pregnancy outcomes, synechia.Results Data were available for 68 of the 85 women (80%) included in the study. Among the 15 women who complained of amenorrhoea or decreased flow of menstruation, synechia was found in all those who decided to undergo an ambulatory hysteroscopy (n = 8). Seventeen women had 26 pregnancies with 19 term deliveries, one ectopic pregnancy, two abortions and four miscarriages. The clinical courses of the 19 complete gestations were uneventful, but postpartum haemorrhage recurred in six women (31.6%) (caused by placenta accreta in two women). Fertility and pregnancy outcomes did not differ between women who had undergone embolisation versus both embolisation and a uterine-sparing surgical procedure. The occurrence of synechia was significantly associated with a higher rate of placenta accreta/ percreta (P < 0.001) and postpartum fever above 38.5°C (P = 0.04).Conclusions Embolisation, whether or not associated with a uterine-sparing surgical procedure, for postpartum haemorrhage does not appear to compromise a woman's subsequent fertility and obstetric outcome. Nevertheless, these women should be considered at high risk for postpartum haemorrhage during future deliveries.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage

Sentilhes

Gromez

Clavier

et al. 2009

BJOG

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“…In another study, Bhal and colloquies showed that, B-Lynch sutures were able to avoid hysterectomy 10 of 11 cases (13). In literature after uterine compression sutures, many successful pregnancies reported (14)(15)(16). One fourth of women with late first or second trimester pregnancy lost or preterm delivery were associated with uterine malformations.…”

Section: Discussionmentioning

confidence: 98%

B-Lynch suture technique to control postpartum hemorrhage in a patient with mullerian anomaly

Boyar¹,

Boynukalın²,

Boyar³

et al. 2011

J Turkish German Gynecol Assoc

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ÖzetCongenital anomalies of the uterus may cause gynecologic, obstetric and fertility problems. Obstetrical complications are reported to occur more commonly with mullerian duct anomalies, such as postpartum hemorrhage (PPH). Uterine compression sutures may be effective in controlling PPH in these conditions as an alternative to hysterectomy, especially if the patient has a desire to conceive. As the shape of the uterus is changed in congenital malformation, the usage of compression sutures such as B-Lynch can be more difficult. In this study we report a case of PPH accompanying a large septae, treated with BLynch suture. A 24 year old, multigravid and nulliparous patient (G:3) was admitted to our clinic with vaginal bleeding and abdominal pain at 31 weeks of gestation. Emergency cesarean section was performed for abruptio placenta and PPH occurred subsequently. A deep uterine septum was revealed during operation. Intermittent fundal massage and intravenous uterotonics were used to improve uterine tonicity without any improvement. After the B-Lynch suture was performed, the bleeding diminished dramatically. As the shape of the uterus is changed in congenital malformation, the application of secondary interventions in postpartum hemorrhage can be more difficult. There can be slippage or overlapping of the suture while using a B-Lynch suture. Because the uterine shape is not completely distorted, patients with septate uterus can be candidates for a B-Lynch suture. There is no such reported case from the literature regarding efficacy of BLynch suture in mullerian anomalies. his case illustrates the potential benefits of B-Lynch compression suture in an uterus with mullerian anomalies.(J Turkish-German Gynecol Assoc 2011; 12: 47-9) Uterin konjenital anomalileri jinekolojik ve obstetrik sorunlara yol aça-bilir ve infertilite ile bulgu verebilir. Postpartum kanama (PPK) ve erken doğum gibi obstetrik komplikasyonlar uterin anomalili olgularda daha sık karşımıza çıkar. Özellikle fertilite arzusu olan olgularda uterin kompresyon sütürleri postpartum kanamanın kontrolünde faydalı olabilir. Uterin anomalide uterusun şeklinin değişmiş olması etkin sütür konulmasını zorlaştırabilir. Bu çalışmada derin uterin septumu olan bir olguda B-Lynch sütürü ile PPK'nın etkin şekilde kontrolü değerlen-dirilmiştir. 24 yaşında G3P0A2 hasta 31 haftalık gebe iken hastanemize vajinal kanama şikayeti ile başvurdu. Hasta plasenta dekolmanı tanı-sıyla acil sezeryana alındı sezeryan sonrası PPK gelişti. İntraoperatif olarak derin uterin septum izlendi. Fundus masajı ve uterotonik ajanlara başvuruldu ancak yanıt alınamadı. B-Lynch sütürü konulduktan sonra kanama kontrol altına alındı. Uterusun şeklinin değişmiş olması nedeniyle kanamayı durdurmak amacıyla kullanılan ikinci basamak yöntemler zorlaşır. Uterusun şeklinin tamamen değişmemiş olduğu septat uterusta B-Lynch sütürü faydalı olabilir. Litaratürde uterin anomalili olgularda B-Lynch sütürünün etkinliğinin değerlendirildiği başka bir olgu sunumu bulunmamaltadır bu olgu sunumu ile ute...

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“…Some authors advocated that use of B-Lynch with stepwise uterine devascularization had no deleterious effect on successful pregnancies [17]. However, there are some reports where B-Lynch was used only for control of postpartum haemorrhage, without any vessel ligation and the pregnancy outcomes in these cases were also favourable [18].…”

Section: Discussionmentioning

confidence: 99%

B-Lynch: A Technique for Uterine Conservation or Deformation? A Case Report with Literature Review

Begum¹

2014

JCDR

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Postpartum haemorrhage is a leading cause of global maternal mortality and morbidity, accounting for 25-30% of all maternal deaths, and 75-90% of these casualties result from uterine atony. Uterine compressive sutures are a well established measure for control of haemorrhage following atonic postpartum haemorrhage, when medical and nonmedical interventions fail.Here, we are reporting a case of secondary infertility in a 24-year-old lady who had undergone an elective caesarean section for central placenta previa in her first pregnancy. She had massive postpartum haemorrhage, for which B-Lynch suture and vessel ligation were done. Subsequently, she failed to conceive for 4 years. This was because of severe pelvic adhesions and uterine deformation which were found intraoperatively, as a consequence of previous use of B-Lynch suture. As no definitive treatment could be offered to her, we suggested her to go for adoption.

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Fertility after B-Lynch suture and stepwise uterine devascularization

Cited by 53 publications

References 17 publications

Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage

Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage

B-Lynch suture technique to control postpartum hemorrhage in a patient with mullerian anomaly

B-Lynch: A Technique for Uterine Conservation or Deformation? A Case Report with Literature Review

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