Uterine compression sutures, an update: review of efficacy, safety and complications of B-Lynch suture and other uterine compression techniques for postpartum haemorrhage

Abstract

Since the advent of uterine compression suture by B-Lynch, numerous techniques have been advocated. We aim to discuss these various techniques with respect to their efficacy, safety, complications, complexity of the technique itself, future fertility and menstrual periods. Since no randomized controlled trials are available, the conclusions are based on weak data derived from observational studies and case series. A success rate of 91.7% has been reported for various uterine compression sutures. There are concerns regarding closure of uterine cavity and blood entrapment resulting in infection, pyometra and adhesions as the uterus will be transfixed from front to back in some of the suturing techniques. Long-term follow-up regarding fertility of patients who had uterine compression sutures is urgently needed. Data on menstrual periods after uterine compression sutures is limited. Our review is limited in nature due to lack of consistent data on many important outcomes and also preclinical variables.

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

“…The surgical method of controlling uterine bleeding by inserting B-Lynch suture has been developed to reduce the incidence of emergency hysterectomy and to preserve fertility in these patients. Because of simplicity of application and less time taken to put the modified B-Lynch stitch, it should be the preferred choice [6]. …”

“…The procedure was simple and effective with the primary goal to compress the uterus without occluding the uterine arteries or uterine cavity [5]. Since this publication, more than 10 variants of uterine compressing sutured have been reported [6–10]. If this method fails, the next step will be vascular ligation (uterine, ovarian and hypogastric) or hysterectomy as a last resort [5].…”

Role of Hayman technique and its modification in recurrent puerperal uterine inversion

“…successfully managed two cases of PPH without hysterotomy 12 . The postoperative courses of all cases were uneventful with a median follow‐up of 11 months 8 …”

“…Hayman technique does not require hysterotomy, so it is not time consuming 7 . Moreover, after application, bleeding can be checked from the vagina by flexion and abduction of both hip and knee joints 8 . B‐lynch technique is equally effective in postpartum hemorrhage but hysterotomy is required to check for emptiness of the cavity and brace suture to the uterus without transfixing the anterior and posterior uterine walls 9 .…”

“…B‐lynch technique is equally effective in postpartum hemorrhage but hysterotomy is required to check for emptiness of the cavity and brace suture to the uterus without transfixing the anterior and posterior uterine walls 9 . Success of B‐lynch stitch depends on checking the arrest of bleeding per vagina by applying bimanual pressure on the exteriorized uterus in the Lloyd Davis (or frog legged) position of the patient 8 . There are no significant differences in failure rates between B‐Lynch sutures and modified B‐Lynch sutures 10 .…”