“A Stitch in Time, Saves Life”; Should B-Lynch Suture be the First Line Surgical Option for Control of Massive Primary PPH due to Refractory Uterine Atony? An Experience at D.H.Q Hospital Faisalabad

Abstract

Objective:

To see the effectiveness of B-Lynch brace suture as first line surgical option to control massive primary postpartum hemorrhage due to uterine atony refractory to medical treatment. Study Design: Quasi experimental. Place and duration of study: This research work was done in D.H.Q Hospital Faisalabad from 2002-2004. During the study period 21 women underwent B-Lynch Brace suture to halt bleeding resulting from refractory uterine atony. Data was collected in prospective manner on a specialized proforma from attending house officers and postgraduate trainee registrars. The B-Lynch technique was used. Postoperatively the patients were kept in high dependency area within labor room for 24-48 hours. Follow up was done in O.P.D after discharge. Materials & Methods: The women who had severe/ persistent primary postpartum hemorrhage dueto uterine atony were initially resuscitated and simultaneously managed with ecbolics as per unit protocol (i-e; 40 units oxytocin in 1000cc Normal Saline infusion, inj. methergen (withheld women with specific contraindications for methergen), inj. F2 alpha in each uterine cornu, and per rectal misoprostol. However those women who remained unresponsive to the medical treatment, underwent B-Lynch Brace suture as first line surgical option. Results: The success rate was 85.7% (n18) in terms of control of hemorrhage and hysterectomy was averted in 95% (n20) of women. Whereas in two women it needed to be integrated with stepwise uterine de-vascularization procedures. Conclusion: B-Lynch suture is effective as first line surgical option to arrest postpartum hemorrhage due to refractory atonic uterus.