Modified anchored B‐Lynch uterine compression suture for post partum bleeding with uterine atony

Abstract

A prospective observational study was performed to evaluate the performance of a modified uterine compression suturing technique for the management of refractory post partum hemorrhage (PPH) at two leading tertiary referral centers in Colombo, Sri Lanka. An modified anchored B-Lynch suture was done in 17 women with PPH due to uterine atony. In 13 of the women (76%), bleeding was arrested and the uterus conserved. Four women (24%) did not respond to the anchored compression sutures, necessitating emergency post partum hysterectomy. Mean age was 31.2 years. Nine of the women (53%) were primiparous and eight (47%) parous. Mean estimated blood loss was 1994 ml (range 1200-3300 ml). This newly modified anchor B-Lynch compression suture appeared effective in controlling about 75% of PPH due to uterine atony, which allowed uterine conservation. This simple modification can provide a first line surgical step to control PPH.

Uterine compression sutures for postpartum hemorrhage: an overview

“…Mostfa and Zaitoun also described this technique and named it the “safety pin suture.” Safety pin corresponds to the “anchored suture” by Marasinghe et al. . Again, these appear the same to us.…”

“…Marasinghe et al. modified the B‐Lynch suture to prevent sliding off, a drawback of the B‐Lynch suture. The needle transfixes the uterine wall below the CS incision site from anterior to posterior, with the needle going around the fundus, and re‐transfixes the uterine fundal portion.…”

Efficacy of surgical techniques to control obstetric hemorrhage: analysis of 539 cases

“…If the uterine fundus is compressed manually while the B‐Lynch loop is tightened, surgical traction on the myometrium is increased. Also, lateral slippage of the ligature loops can be avoided by inserting a stitch through the uterine dome before traversing its posterior side (19; Figure 2). After performing myometrial hemostatic procedures, it is not wise to use oxytocics or postsurgical uterine massage.…”

Risk of synechiae following uterine compression sutures

“…The use of modified B‐Lynch UCS, as described by Hayman et al 3 . and Marasinghe et al., 4 may be a plausible solution to this problem. In these descriptions, the sutures are placed unilaterally and separately.…”