B‐Lynch suture for massive persistent postpartum hemorrhage following stepwise uterine devascularization

Abstract

B-Lynch technique appears to be an effective procedure with a relatively low morbidity to control persistent severe PPH following a failure of vessel ligation before considering hysterectomy.

Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage

“…The policy management for PPH has been reported previously. 7,8,27 Digital subtraction angiography was performed using a right-sided unifemoral approach. After aortography to determine anatomy and to locate possible extravasation of contrast agent, selective catheterisation of the uterine artery or anterior trunk of the hypogastric artery was performed.…”

“…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.…”

“…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.…”

Uterine necrosis in a case of B-Lynch brace suture

“…The success rate of this suture is 86.4% in avoiding obstetric hysterectomy and thus this suture are widely recommended for atonic PPH. 4 Successful pregnancies have been reported after B-Lynch suture. These uterine compression sutures can cause complication like hematometra, pyometra, asherman's syndrome, uterine necrosis.…”

“…The advantages of B-lynch suture is that it appears to be an effective to control severe persistent PPH following failure of vessel ligation before considering obstetric hyterectomy. 4 To date only few complications of this procedure have been reported. We would like to report a case of B-Lynch suture which caused erosion and necrosis of the uterine wall resulting in peritonitis with sepsis identified on day 16 postpartum.…”