DISCOVERIES REPORTS (ISSN 2393249X), 2022, volume 5
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: email@example.com
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.
Access FULL text of the manuscript here: FULL ARTICLE (PDF)
1. B-Lynch C, Meyer KK, Javaid TA. B-Lynch Transverse Compression Suture for PPH Placenta Previa Bleeding. Nepal J Obstet Gynaecol. 2014;9(2):1-2.
2. Sathe NA, Likis FE, Young JL, Morgans A, Carlson-Bremer D, Andrews J. Procedures and uterine-sparing surgeries for managing postpartum hemorrhage: a systematic review. Obstet Gynecol Surv. 2016;71:99- 113.
3. Moleiro ML, Braga J, Machado MJ, Guedes-Martins L. Uterine Compression Sutures in Controlling Postpartum Haemorrhage: A Narrative Review. Acta Med Port. 2022 Jan 3;35(1):51-58.
4. Doumouchtsis SK, Papageorghiou AT. Systematic review of conservative management of postpartum hemorrhage: what to do when medical treatment fails. Obstet Gynecol Surv. 2007;62:540-7.
5. Shah M, Wright JD. Surgical intervention in the management of postpartum hemorrhage. Semin Perinatol. 2009;33:109-15.
6. Palacios-Jaraquemada JM. Efficacy of surgical techniques to control obstetric hemorrhage: analysis of 539 cases. Acta Obstet Gynecol Scand. 2011;90:1036-42.
7. Savcı G, Ozdemir AZ, Karlı P, Kocak I, Katırcı Y, Onal M. A different method in the treatment of placenta previa: A comparison of lower uterine segment transverse suture technique and Bakri balloon application. Open J Obstet Gynecol 2019;9:334-42.
8. Price N, B-Lynch C. Technical description of the B-Lynch brace suture for treatment of massive postpartum hemorrhage and review of published cases. Int J Fertil Womens Med. 2005 Jul-Aug;50(4):148-63.
9. Matsubara S, Yano H, Ohkuchi A, Kuwata T, Usui R, Suzuki M. Uterine compression sutures for postpartum hemorrhage: an overview. Acta Obstet Gynecol Scand. 2013 Apr;92(4):378-85.
10. B-Lynch C, Coker A, Lawal AH, Abu J, Cowen MJ. The B-Lynch surgical technique for the control of massive postpartum haemorrhage: an alternative to hysterectomy? Five cases reported. Br J Obstet Gynaecol. 1997;104:372–5.
11. Hayman RG, Arulkumaran S, Steer PJ. Uterinecompression sutures: surgical management of postpartum hemorrhage. Obstet Gynecol. 2002;99:502–6.
12. Cho JH, Jun HS, Lee CN. Hemostatic suturing technique for uterine bleeding during cesarean delivery. ObstetGynecol. 2000;96:129–31.
13. Pereira A, Nunes F, Pedroso S, Saraiva J, Retto H,Meirinho M. Compressive uterine sutures to treat postpartum bleeding secondary to uterine atony. ObstetGynecol. 2005;106:569–72.
14. Ouahba J, Piketty M, Huel C, Azarian M, Feraud O, LutonD, et al. Uterine compression sutures for postpartum bleeding with uterine atony. Br J Obstet Gynaecol.2007;114:619–22.
15. Hackethal A, Brueggmann D, Oehmke F, Tinneberg HR,Zygmunt MT, Muenstedt K. Uterine compression U-sutures in primary postpartum hemorrhage after Cesarean section: fertility preservation with a simple and effectivetechnique. Hum Reprod. 2008;23:74–9.
16. Matsubara S, Yano H, Taneichi A, Suzuki M. Uterinecompression suture against impending recurrence ofuterine inversion immediately after laparotomy repositioning. J Obstet Gynaecol Res. 2009;35:819–23.
17. Matsubara S. A new compression suture to prevent 'uterine sandwich' from sliding off. Acta Obstet Gynecol Scand. 2012 May;91(5):638-9.
18. Mondal PC, Ghosh D, Santra D, Majhi AK, Mondal A, Dasgupta S. Role of Hayman technique and its modification in recurrent puerperal uterine inversion. J Obstet Gynaecol Res. 2012 Feb;38(2):438-41.
19. Songthamwat S, Songthamwat M. Uterine flexion suture: modified B-Lynch uterine compression suture for the treatment of uterine atony during cesarean section. Int J Womens Health. 2018 Aug 24;10:487-492.
20. Begum J, Pallave P, Ghose S. B-lynch: a technique for uterine conservation or deformation? A case report with literature review. J Clin Diagn Res. 2014 Apr;8(4):OD01-3.
21. WHO guidelines for the management of postpartum hemorrhage and retained placenta. Geneva: World Health Organisation, c2009
22. Sentilhes L, Gromez A, Descamps P, Marpeau L. Why stepwise uterine devascularisation should be the first line conservative surgical treatment to control severe Postpartum hemorrhage? Acta Obstet Gyn Scan. 2009;88(4):490–2.