Uterine salvage management for atonic postpartum hemorrhage using “modified lynch suture”

Abstract

BackgroundTo assess the effectiveness of the new modified technique in order to control bleeding in women presenting with atonic, flabby uterus compared to the most commonly described technique of classic B-Lynch suture.MethodThis study included 160 women of uncontrolled atonic postpartum hemorrhage delivered by cesarean section at Ain Shams University Maternity Hospital between January 2013 and October 2015. Participants were randomly assigned following simple randomization procedures (computerized random numbers) and divided into two groups. Group, I (80 patients) operated upon by the modified (new technique) stitch while group II (80 patients) operated upon by the classic technique. The ultimate goals were to stop blood loss after placement of the sutures and avoid life-saving hysterectomy thus preserving the life and fertility of the patient.ResultsThe modified new technique was done in 80 patients with atonic postpartum hemorrhage and it was found to be superior to the classic technique with a success rate 95 % (4 cases needed hysterectomy as a lifesaving measure) compared to 85 % with the classic technique (in 12 cases, a life-saving hysterectomy was done).ConclusionsThis technique can replace the classic B-lynch in flabby unresponsive atonic uteri as it has 8 shaped placement of the stitch which causes more firm compression on the uterus and simultaneous bilateral uterine artery ligation. This technique was proved valuable and successful in many patients who suffer from uncontrolled massive postpartum hemorrhage (PPH).

Uterine Compression Sutures in Controlling Postpartum Haemorrhage: A Narrative Review

“…3C). 21,35 El-Sokkary et al 22 have published another variation: it begins on the anterior aspect of the uterus below the hysterotomy, but the thread, after exiting above the hysterotomy, crosses the uterine fundus on the contralateral side and is inserted in the posterior wall on that same side. On the posterior aspect of the uterus the suture is performed as B-Lynch description but on the anterior wall the thread crosses again creating an X-shaped suture.…”

“…On the posterior aspect of the uterus the suture is performed as B-Lynch description but on the anterior wall the thread crosses again creating an X-shaped suture. 22 The association of B-Lynch suture with other postpartum haemorrhage control techniques have also been described. Nelson and O'Brien 29 have reported five cases in which B-Lynch's compression sutures were performed but were not successful, so they've applied an intrauterine Bakri balloon -'uterine sandwich technique'.…”

“…These reports describe different suture techniques that may be used to treat uterine atony or haemorrhage due to placenta praevia or accreta. 16,[18][19][20][21][22][23][24][25][26][27][28][29][30][31] Given the importance of uterine compression sutures to preserve fertility potential, we aimed to present the different types of sutures, how they are performed, their complications and impact on fertility. Our final goal was to understand when and how these techniques should be chosen over more interventional surgical procedures and which one is more suitable for each situation.…”

Atonic Primary Postpartum Haemorrhage; The Efficacy of B-Lynch Suture in Management During Cesarean Section

“…This is close to the study done by ElSokkary et al in Cairo, Egypt where they found that the mean age was 29.3 years. 12 Similarly, Nalini et al reported 28 years mean age. 13 On the contrary, Koh et al reported 35 years as the mean age 14 , which can be explained by elderly gravid uterus leading to atonicity and thus PPH.…”

Complications of Cesarean Operation

“…Since its creation, several authors have described modifications to the original technique; however, all handle the same concept, that is, uterine compression [27,28].…”