The B-Lynch suture technique for postpartum haemorrhage: A decade of experience and outcome

Abstract

Historically, postpartum haemorrhage (PPH) has resulted in mortality and morbidity. Of the three well known messengers of death in obstetric practice, severe postpartum haemorrhage is the most menacing for the midwife and obstetrician. Mumtaz Mahal (1630--Wife of Emperor Shah Jahan) and Princess Charlotte Augusta of Wales (1817) both died from massive PPH. William Smellie, one of the greatest obstetricians, wrote his famous treaty on death resulting from uncontrollable massive postpartum haemorrhage. Improvements over the last 100 years include the introduction of ergometrine and prostaglandin and the invention of the B-Lynch suture and its modifications to improve the conservative management of this life-threatening condition. The B-Lynch surgical technique was first invented in 1997 and it is now timely to review a decade of experience and publications. The rising caesarean section rate and the emergency nature of most PPH remain a constant reminder for the need of effective intervention. A robust protocol is essential (one is being produced by this team) to manage this problem with consensus between obstetricians, anaesthetists, midwives, interventional radiologist and haematologist for prompt and coordinative care in such a life-threatening situation. Modifications of B-Lynch technique were introduced later (Cho et al. 2000; Hayman et al. 2002) and need careful evaluation.

Evaluation of “J”-shaped uterine incision during caesarean section in patients with placenta previa: A retrospective study

“…Due to the extensive introduction of prenatal examinations, placenta previa can be identified and treated before severe bleeding happens [13][14][15] . The major treatment is caesarean section to terminate the pregnancy at appropriate time of gestation (35-36 weeks), and the procedure plays an important role in decreasing perinatal morbidity and mortality [16][17][18] .…”

Le ballonnet de Bakri

“…Nelson et O'Brien [18] rapportent une sé rie ré trospective de cinq cas de cé sarienne compliqué e d'une atonie uté rine, tous efficacement traité s par l'association d'un B-Lynch [19] et d'un tamponnement intra-uté rin par ballonnet de Bakri. Cependant, là encore l'effectif de la sé rie est faible et le ballonnet n'a pas é té utilisé seul pour traiter l'HDD.…”

Sutura de B-Lynch en hemorragia postparto por inercia uterina. Experiencia Hospital Dr. Luis Tisné Brousse 2013-2016

“…Ocurre en aproximadamente el 4% de los partos vaginales y el 6% de los partos por cesárea 4 . En nuestro país, según el departamento de estadísticas e información de salud (DEIS), en el año 2014, la mortalidad materna antes de los 42 días post parto alcanza una razón de 13,5, siendo la HPP la séptima causa con una razón de 0,4 por 100.000 nacidos vivos corregidos 5 .…”

“…Dentro de las técnicas quirúrgicas conservadoras, existen las suturas compresivas, tales como la sutura de B-Lynch, la cual se realizó por primera vez en 1989 y luego se describe en 1997 por Christopher B-Lynch 4 . Consiste en un tratamiento quirúrgico conservador que puede ser recomendado para la mayoría de las situaciones.…”

“…Mantiene la compresión longitudinal, con una distribución uniforme de la tensión en las paredes uterinas, incluso cuando la presión de pulso de la pelvis vuelve a la normalidad 6 . Se han publicado alrededor de 1.600 casos en todo el mundo desde la descripción de la técnica 4 .…”