Successful Management of Postpartum Hemorrhage Using B-Lynch Suture

Background: Postpartum haemorrhage (PPH) is a life threatening obstetric emergency. In Pakistan 25% of maternal deaths are due to PPH and majority is due to uterine atony. B-Lynch suture is a simple and effective method for control of PPH due to uterine atony as an alternative to more complicated surgery including hysterectomy with loss of fertility and associated psychological morbidity. Objective: To demonstrate the effectiveness of B-Lynch compression suture in patients with massive postpartum haemorrhage due to uterine atony refractory to medical treatment. Methods: Prospective observational study conducted at Sobhraj Maternity Hospital, Karachi, from January 1, 2012 to December 31, 2012. Data was collected during the 12 month period for all women who had massive primary postpartum haemorrhage (> 1500ml) due to uterine atony refractory to uterotonic agents in whom surgical haemostasis was initiated by applying B-Lynch suture. Patients were followed up at 6 weeks, 6 months and 12 months. The main outcomes evaluated were reduction or cessation of bleeding, whether hysterectomy was needed to control haemorrhage and whether minor or major complications of the procedure arose. Results: During the 12 months study period 3.1% (152/4782) women had primary postpartum haemorrhage, while massive postpartum haemorrhage occurred in 0.62% (30/4782) cases. Majority of these cases were due to uterine atony (20/30). B-Lynch suture was applied to 16 women who had massive primary postpartum haemorrhage due to uterine atony refractory to uterotonic agents. Effective haemostasis was achieved in all cases. None of the women required hysterectomy. All women later resumed normal menstrual flow without any abnormality. One patient had spontaneous pregnancy after eleven months of her delivery. Conclusion: B-Lynch suture is effective in the control of massive postpartum haemorrhage as an alternative to hysterectomy, a lifesaving procedure preserving the uterus and thus fertility.