Successful of the B-Lynch compression suture in the management of massive postpartum hemorrhage: case reports and review

Habek, Dubravko; Kulaš, Tomislav; Bobić-Vuković, Mirna; Selthofer, Robert; Vujić, Bojana; Ugljarević, Margareta

doi:10.1007/s00404-005-0059-1

Cited by 25 publications

(18 citation statements)

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“…In two patients, primary postpartal hemorrhage was caused by uterine atony (because of disproportion and distended uterus due to polyhydramnios), whereas in one patient massive postpartal hemorrhage was caused by uterine atony and thrombophilia. The use of compressive operative methods of hemostasis for uterine atony of various etiologies and invasive forms of abnormal placentation has definitely reduced the incidence of EPH, as also demonstrated in our study [4] . According to recent studies, forms of invasive malplacentation (placenta accreta, increta, percreta) is a major isolated risk factor for EPH because uterine atony, hemorrhage for placental site, and invasive penetration in other organs (e.g., urinary bladder) as shown in the present study.…”

Section: Discussionsupporting

confidence: 58%

“…Total hysterectomy was performed in 24 patients, and subtotal hysterectomy in 10 patients. The indications for EPH were uterine rupture [4] , placenta accreta [11] , uterine atony [8] , and massive postpartal hemorrhage [6] . There were two maternal deaths, six stillbirths, and two early neonatal deaths.…”

Section: Discussionmentioning

confidence: 99%

“…Peripartum hemorrhage is most commonly caused by uterine atony or coagulopathy (disseminated intravascular coagulopathy or thrombophilia). If there is no response to mechanic (uterus compression, uterine thamponade) or medicamentous therapy (uterotonics, uterostiptics, prostaglandins, recombinant activated factor VII), surgical therapy by vascular sutures is indicated or in present days by conservative compressive procedures like B-Lynch compressive suture or Z-suture of the uterus [1][2][3][4] .…”

Section: Introductionmentioning

confidence: 99%

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Emergency Peripartum Hysterectomy in a Tertiary Obstetric Center: 8-Year Evaluation

Habek¹,

Bečarević

2006

Fetal Diagn Ther

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Objective: The aim of the study was to present the incidence, indications, and operative morbidity and mortality in pregnant women undergoing emergency peripartum hysterectomy (EPH) at a tertiary obstetric institution. Methods: In this retrospective clinical study, performed during the period 1995–2003, 17 EPH procedures were recorded in a total of 21,659 deliveries carried out at Department of Gynecology and Obstetrics, Osijek Clinical Hospital in Osijek, Croatia. Data on the incidence of EPH in total number of deliveries, rate of EPH in vaginal delivery and cesarean section, indications for EPH, and maternal and fetal/early neonatal morbidity and mortality were derived from operative protocols and medical records of hospitalized patients. Results: During the 8-year study period, the incidence of EPH in total number of deliveries was 0.078%. Out of 17 EPH procedures, 5 (29.41%) were performed after vaginal delivery and 12 (70.59%) during cesarean section, elective in five and urgent in seven cases. The indications for EPH included severe peripartum hemorrhage with placenta previa in four, placenta previa percreta in four, various forms of invasive malplacentation (placenta accreta, increta, percreta) in five, uterine rupture in two cases, and atony along with massive retroperitoneal hematoma due to rupture of periuterine vascular bundle during cesarean section in one multipara. EPH was carried out in 12 multipara and five primipara. Lesions of urinary bladder occurred in three cases and were managed by suture. Twelve patients received blood transfusion, whereas development of hemorrhagic shock necessitated transfer to Intensive Care Unit in three patients. No late complications or maternal mortality were recorded. Sixteen total hysterectomies and one supracervical hysterectomy were performed. One case of intrauterine fetal death was caused by total abruptio placenta and uterine rupture during the patient’s transport from a primary obstetric institution. Conclusion: Invasive malplacentation is a major isolated risk factor for EPH, as shown in the present study. Other risk factors for EPH are massive hemorrhagy because placenta previa, uterine atony and uterine rupture associated with multiparity, and previous cesarean section. A great proportion of EPH procedures can be prevented by the introduction of compressive operative methods such as B-Lynch suture in the obstetric algorithms, which will certainly favorably reflect in future fertility and genital health of the female population.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Emergency Peripartum Hysterectomy in a Tertiary Obstetric Center: 8-Year Evaluation

Habek¹,

Bečarević

2006

Fetal Diagn Ther

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“…Using these methods, the volume of the uterus is reduced; the uterus is also compressed and therefore any further hemorrhage can be stopped. Urgent hysterectomy is reserved for resilient, heavy hemorrhage which cannot be stopped using any of the above-mentioned methods [2,3] .…”

Section: Discussionmentioning

confidence: 99%

Successful Term Pregnancy after B-Lynch Compression Suture in a Previous Pregnancy on Account of Massive Primary Postpartum Hemorrhage

et al. 2006

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A case is presented of a successful term pregnancy in a 28-year-old secundipara after previous Misgav-Ladach cesarean section and B-Lynch compression suture on account of massive postpartal hemorrhage caused by uterine atony. On account of dystocia and relative cephalopelvic disproportion, secondary repeated cesarean section was performed; she gave birth to a live child 3,900 g/52 cm, Apgar score 9/10, with a regular neonatal course. During the repeated cesarean section, thin laces of connective tissue were found along the sutures placed on the uterus during the previous B-Lynch operation. Pelvic and intrauterine adhesions were not found.

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“…The technique of the B-Lynch is as follows 2,38,39 The patient should to be in the Lloyd Davis position and a laparotomy performed. A lower transverse incision in the uterus is made and the cavity inspected for retained products and partial tears or rupture.…”

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confidence: 99%

Common errors and remedies in managing postpartum haemorrhage

Lombaard

Pattinson

2009

Best Practice & Research Clinical Obstetrics & Gynaecol

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Keywords: postpartum haemorrhage maternal morbidity and mortality B-Lynch internal iliac ligation uterine tamponade cell saver Postpartum haemorrhage (PPH) is a major contributor to maternal morbidity and mortality. By only examining mortality, the full extent of the problem is not revealed and also it is important to evaluate the avoidable factors. This will identify the areas that need attention. The common errors include not treating anaemia in pregnancy, not practicing active management of the third stage of labour, delay in recognition, substandard care and lack of skills. The remedies include the correct medical treatment of PPH and the use of uterine tamponade. Cell savers can help to reduce the need for transfusion and transfusion associated complications. There are new treatment modalities such as embolisation that can be of value in certain settings.

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Successful of the B-Lynch compression suture in the management of massive postpartum hemorrhage: case reports and review

Cited by 25 publications

References 5 publications

Emergency Peripartum Hysterectomy in a Tertiary Obstetric Center: 8-Year Evaluation

Emergency Peripartum Hysterectomy in a Tertiary Obstetric Center: 8-Year Evaluation

Successful Term Pregnancy after B-Lynch Compression Suture in a Previous Pregnancy on Account of Massive Primary Postpartum Hemorrhage

Common errors and remedies in managing postpartum haemorrhage

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