DISCOVERIES REPORTS (ISSN 2393249X), 2022, volume 5

ORIGINAL ARTICLE

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CITATION: Karena Z, Mehta A, Ladhani K, Gadhia V, Rao R. Management of Postpartum Hemorrhage due to Placenta Previa: A Case Series of Transverse B-Lynch Uterine Compression Sutures. Discoveries Reports 2022; 5(2): e31. DOI: 10.15190/drep.2022.5

Management of Postpartum Hemorrhage due to Placenta Previa: A Case Series of Transverse B-Lynch Uterine Compression Suture

Zalak Karena 1,*, Aditya Mehta 1, Kavita  Ladhani 1, Vishnu Gadhia 1, Rajvee Rao 1

1Pandit Deendayal Upadhyay Medical College, Rajkot, India

* Corresponding author: Prof. Zalak Karena, Pandit Deendayal Upadhyay Medical College, Rajkot, India; Email: zkarenawork@gmail.com

Abstract

Postpartum hemorrhage is one the major contributors to maternal death. with postpartum hemorrhage due to placenta previa being one of the most challenging conditions for the obstetricians to tackle intraoperatively. Uterine compression sutures have their own fair place in the management of postpartum hemorrhage, and it is recommended by the World Health Organization in the case of failed medical management. Currently, there are a variety of uterine compression sutures available for the management of atonic postpartum hemorrhage. In this case series, we detail a novel surgical technique for managing postpartum hemorrhage in the case of placenta previa, where placental bed bleeding and the lower uterine segment atony can cause torrential bleeding and postpartum hemorrhage. This technique named Transverse B-Lynch compression suture is used for the compression of lower uterine segment at the incision site of caesarean section in placenta previa. Here, we have retrospectively reviewed the case records of all the patients delivered by caesarean section from 2017 to 2022, having postpartum hemorrhage intraoperatively and managed by Transverse B-Lynch compression suture. Six women with postpartum hemorrhage had been managed by Transverse B-Lynch compression suture, while been operated for placenta previa. The mean age of the patients was 26.83 ± 3.96 years and the mean gestational age at delivery was 36 ± 1.24 weeks. The primary outcome, effectiveness of the procedure to conserve uterus, was 100 %. The average estimated blood loss was 1.95 ± 0.44 L. The mean procedure time to perform the compression suture was 6.33 ± 1.65 minutes and the mean time from removal of placenta to decision to perform Transverse B-Lynch compression suture was 84.16 ± 10.25 minutes. The mean intraoperative time was 117.5 ± 15.95 minutes. In all 6 patients, it was possible to control postpartum hemorrhage with the compression suture. Further surgical intervention of any kind following the compression suture was not required. No patient required further hypogastric artery ligation or hysterectomy. Hence, Transverse B-Lynch uterine compression suture is an effective surgical method for the treatment of postpartum hemorrhage in placenta previa, preserving fertility by avoiding hysterectomy. However, large and more comprehensive studies need to be performed in order to further investigate and validate these findings.

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