Clinical outcome analysis of modified B-Lynch sutures in the fundus uteri and part of the corpus uteri for the prevention of intraoperative haemorrhage during caesarean delivery in women with twin pregnancy: a retrospective study

Shi, Chunbo; Chen, Jinliang; Chen, Aner

doi:10.1186/s12884-023-05759-3

Cited by 3 publications

(1 citation statement)

References 21 publications

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“…Uterine compression suture techniques for PPH were developed in the 1990s, including the B-Lynch suture [ 9 ], modified B-Lynch sutures [ 10 ], Hayman suture [ 11 ], and Cho suture [ 12 ]. Among these uterine compression suture techniques, the B-Lynch suture is the earliest and most widely used method all over the world [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

A new step-wise surgical technique of knapsack-like uterine compression sutures for intractable postpartum hemorrhage in cesarean section

Han,

Zhang,

et al. 2024

BMC Pregnancy Childbirth

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Background Intractable postpartum hemorrhage (PPH) during cesarean section has been a significant concern for obstetricians. We aimed to explore the effectiveness and safety of a new type of uterine compression suture, the step-wise surgical technique of knapsack-like sutures for treating intractable PPH caused by uterine atony and placenta factors in cesarean section. Methods The step-wise surgical technique of knapsack-like sutures was established on the basis of the artful combination of vertical strap-like sutures and an annular suture-ligation technique. This novel surgical technique was applied to 34 patients diagnosed with PPH during cesarean section due to severe uterine atony and placental factors in our department. The hemostatic effects, clinical outcomes and follow-up visit results were all reviewed and analyzed. Results This new uterine compression suture successfully stopped bleeding in 33 patients, and the effective rate was 97.06%. Only 1 patient failed and was changed to use bilateral uterine arterial embolization and internal iliac artery embolization. The follow-up visits indicated that 33 patients restored menstruation except for 1 who was diagnosed with amenorrhea. The gynecological ultrasound tests of all the patients suggested good uterine involutions, and they had no obvious complaints such as hypogastralgia. Conclusions This step-wise surgical technique of knapsack-like uterine compression sutures can compress the uterus completely. It is a technique that can conserve the uterus and fertility function without special equipment in caesarean section for PPH, with the characteristics of being safe, simple and stable (3 S) with rapid surgery, reliable hemostasis and resident doctor to operation (3R).

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Section: Introductionmentioning

confidence: 99%

A new step-wise surgical technique of knapsack-like uterine compression sutures for intractable postpartum hemorrhage in cesarean section

Han,

Zhang,

et al. 2024

BMC Pregnancy Childbirth

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MR imaging features of uterine necrosis following modified B-Lynch sutures: a case report

Thakur,

Jhobta,

Surya

et al. 2024

Egypt J Radiol Nucl Med

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Background B-Lynch braided compression sutures are applied as a lifesaving procedure to control atonic post-partum hemorrhage if the patient is not responding to uterotonics and other conservative methods. These sutures are applied to avoid hysterectomy so as to preserve fertility. However, if not applied properly, these can lead to a rare but serious complication of uterine necrosis secondary to uterine ischemia and sepsis. The patient then ends up in hysterectomy defeating the sole purpose of maintaining fertility for which the sutures were applied at the first place. Case presentation Here we describe a case of primipara who had caesarian section complicated by post-partum hemorrhage which was managed with modified B-Lynch compression sutures for achieving hemostasis. The patient presented three weeks post-procedure with signs and symptoms of inflammation and sepsis. The MR imaging revealed features of uterine necrosis. The patient underwent hysterectomy unwillingly as no other option was left to save her life. A detailed MR imaging of this case has been described given the scarcity of MR features of uterine necrosis following compressive sutures in medical literature. Conclusions The case is reported to make the clinicians aware of the possibility of such a dreaded complication following compressive sutures for post-partum hemorrhage and to emphasize on early and timely follow-up of such patients so that uterus could be salvaged.

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An Integrated Approach to the Prevention of Postpartum Bleeding in High-Risk Patients

Artymuk,

Apresyan,

Artymuk

et al. 2024

Fundamentalʹnaâ i kliničeskaâ medicina

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Aim. To evaluate the effectiveness of an integrated approach to the prevention of postpartum hemorrhage (PPH) in high-risk patients using uterine balloon tamponade with a double-balloon system, double-sided compression suture on the lower uterine segment, and administration of a uterotonic drug.Materials and Methods. Here we performed an open-label, comparative, controlled clinical trial aimed at establishing superiority. 144 pregnant patients with a high risk of PPH were randomised into 2 groups of 72 patients each. When implementing the study protocol, 22 patients were excluded from the treatment group, and 1 patient was excluded from the control group. In the treatment group, in addition to routine prevention, we applied an original technique which included uterine balloon tamponade with a double-balloon system, double-sided compression suture in the lower uterine segment, and intravenous administration of carbetocin. Control group received routine prevention of PPH. Statistical data analysis was carried out using Python version 3.11.Results. The volume of blood loss ranged from 500 to 1900 mL in the treatment group and from 400 to 3900 mL in the control group (p = 0.375). In the treatment group, the incidence of PPH was significantly lower than in the control group (10.00% and 49.30%, respectively, p < 0.0001), as well as the frequency of blood loss > 1000 mL (20.00% and 39.44%, respectively, p = 0.002). Blood loss > 2000 mL was recorded exclusively in the control group (12.69% patients). Among the secondary outcomes, blood products were used significantly less frequently in patients of the treatment group compared to the control group (12.00% and 29.58%, respectively, p = 0.027); hysterectomy was performed only in 6 (8.45%) patients of the control group. The duration of hospitalisation after childbirth did not differ significantly between the groups.Conclusion. An integrated approach to the prevention of PPH, which employs a double-sided compression suture on the lower uterine segment, uterine balloon tamponade using a double-balloon Zhukovsky system, and intravenous administration of a uterotonic drug, is more effective in preventing PPH in high-risk patients as compared with routine practice. Further multicenter extended studies in this direction are needed.

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Clinical outcome analysis of modified B-Lynch sutures in the fundus uteri and part of the corpus uteri for the prevention of intraoperative haemorrhage during caesarean delivery in women with twin pregnancy: a retrospective study

Cited by 3 publications

References 21 publications

A new step-wise surgical technique of knapsack-like uterine compression sutures for intractable postpartum hemorrhage in cesarean section

A new step-wise surgical technique of knapsack-like uterine compression sutures for intractable postpartum hemorrhage in cesarean section

MR imaging features of uterine necrosis following modified B-Lynch sutures: a case report

An Integrated Approach to the Prevention of Postpartum Bleeding in High-Risk Patients

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