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Muacevic A, Adler JR, Prasad MK, Singh AV, Sharma S, Singh B, Singh TH, Kumar P, Singh HV, Singh S. Obstetric and Maternal Outcomes After B-Lynch Compression Sutures: A Meta-Analysis. Cureus 2022; 14:e31306. [PMID: 36514660 PMCID: PMC9734287 DOI: 10.7759/cureus.31306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 11/11/2022] Open
Abstract
This review article aimed to determine the obstetric and maternal outcomes after B-Lynch compression sutures to control atonic postpartum hemorrhage (PPH). This meta-analysis was performed after registering the protocol in the PROSPERO database with the registration number CRD42022355358. Two independent reviewers systematically searched electronic databases and search engines (PubMed, Cochrane Library, and Google Scholar) to retrieve published articles from inception to July 2022. The obstetric and maternal outcomes after the B-Lynch compression suture were computed using the random-effects model in pooled proportion with a 95% confidence interval (CI). Meta-regression analysis and subgroup analysis were performed to explain any source of possible heterogeneity. Quality assessment of the included studies was done using Joanna Briggs Institute (JBI) tools which are critical appraisal tools for systematic reviews and meta-analyses. This meta-analysis included a total of 30 studies involving 1,270 subjects. The pooled proportion of B-Lynch suture alone was 91% (95% CI = 82-97%). The combined proportion of B-Lynch suture plus another compression suture was 1% (95% CI = 0-3%), and the pooled proportion of B-Lynch suture plus vessel ligation was 3% (95% CI = 1-6%). The pooled proportions of PPH controlled and hysterectomies were 94% (95% CI = 91-97%, I2 = 65.3%) and 7% (95% CI = 4-10%, I2 = 72.13%), respectively. Therefore, B-Lynch suture (either alone or in combination with other techniques) is a simple and effective measure to control atonic PPH.
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Kaya B, Tuten A, Daglar K, Onkun M, Sucu S, Dogan A, Unal O, Guralp O. B-Lynch uterine compression sutures in the conservative surgical management of uterine atony. Arch Gynecol Obstet 2015; 291:1005-14. [PMID: 25315382 DOI: 10.1007/s00404-014-3511-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
Abstract
AIM To evaluate the success rate and possible complications of the B-Lynch uterine compression sutures in women who suffered from postpartum uterine atony unresponsive to medical treatment. MATERIALS AND METHODS A total of 36 women who were managed with the B-Lynch suture, with or without additional surgical procedures following uterine atony unresponsive to medical treatment, were evaluated retrospectively. RESULTS Sixteen women were primarily managed with the B-Lynch compression sutures, and 11 women had the B-Lynch compression sutures following failure of achievement of hemostasis by ligation of uterine artery alone (n = 4), or uterine artery plus uterine branch of ovarian artery (n = 7). Eight women had bilateral internal iliac artery ligation (BIIAL) following failure of achievement of hemostasis by the B-Lynch compression sutures. Two women (5.5%) underwent post-cesarean hysterectomy. The overall success rate of B-Lynch was 75% (27/36), and the overall success rate of B-Lynch plus BIIAL was 94.4% (34/36). Three women were admitted to the intensive care unit. There was no death related to the hemorrhage in our series. No short-term complications such as uterine necrosis, hematometra, pyometra, or uterine erosion related to the uterine compression suture were observed. CONCLUSION Overall success rate of the B-Lynch sutures and B-Lynch sutures plus BIIAL was 75 and 94.4%, respectively. The B-Lynch technique does not necessarily require specific suture material. Uterine devascularization or BIIAL did not increase the risk of the possible short-term complications such as uterine necrosis. In case of failure of the B-Lynch uterine compression sutures, BIIAL may be beneficial to save the uterus.
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Fotopoulou C, Dudenhausen JW. Uterine compression sutures for preserving fertility in severe postpartum haemorrhage: An overview 13 years after the first description. J OBSTET GYNAECOL 2010; 30:339-49. [DOI: 10.3109/01443611003650233] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- C. Fotopoulou
- Department of Gynecology and Obstetrics, Charité, Campus Virchow Clinic, University Hospital, Berlin, Germany
| | - J. W. Dudenhausen
- Department of Gynecology and Obstetrics, Charité, Campus Virchow Clinic, University Hospital, Berlin, Germany
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Goojha CA, Case A, Pierson R. Development of Asherman syndrome after conservative surgical management of intractable postpartum hemorrhage. Fertil Steril 2010; 94:1098.e1-5. [PMID: 20347081 DOI: 10.1016/j.fertnstert.2010.01.078] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 01/27/2010] [Accepted: 01/28/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Describe a case of secondary infertility due to the development of severe Asherman Syndrome after the B-Lynch compression suture and uterine artery ligation, and to review the B-Lynch technique and documented complications. DESIGN Case report. SETTING Tertiary care hospital. PATIENT(S) A 29-year-old primigravida patient. INTERVENTION(S) B-Lynch suture and uterine artery ligation. MAIN OUTCOME MEASURE(S) Development of Asherman syndrome. RESULT(S) Development of secondary infertility due to Asherman syndrome after the B-Lynch suture. CONCLUSION(S) The B-Lynch suture is a highly successful conservative surgical technique used to treat this condition. There is little information regarding any potential for compromised future fertility, although there have been several reports of successful pregnancy after the use of the B-Lynch compression suture. In this report, we present a case of Asherman syndrome with complete obliteration of the uterine cavity after the B-Lynch suture.
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Affiliation(s)
- Ciaran A Goojha
- Department of Obstetrics, Gynecology, and Reproductive Sciences, College of Medicine, University of Saskatchewan, Royal University Hospital, Saskatoon, Saskatchewan, Canada.
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Weisbrod AB, Sheppard FR, Chernofsky MR, Blankenship CL, Gage F, Wind G, Elster EA, Liston WA. Emergent management of postpartum hemorrhage for the general and acute care surgeon. World J Emerg Surg 2009; 4:43. [PMID: 19939251 PMCID: PMC2788527 DOI: 10.1186/1749-7922-4-43] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Accepted: 11/25/2009] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Postpartum hemorrhage is one of the rare occasions when a general or acute care surgeon may be emergently called to labor and delivery, a situation in which time is limited and the stakes high. Unfortunately, there is generally a paucity of exposure and information available to surgeons regarding this topic: obstetric training is rarely found in contemporary surgical residency curricula and is omitted nearly completely from general and acute care surgery literature and continuing medical education. METHODS The purpose of this manuscript is to serve as a topic specific review for surgeons and to present a surgeon oriented management algorithm. Medline and Ovid databases were utilized in a comprehensive literature review regarding the management of postpartum hemorrhage and a management algorithm for surgeons developed based upon a collaborative panel of general, acute care, trauma and obstetrical surgeons' review of the literature and expert opinion. RESULTS A stepwise approach for surgeons of the medical and surgical interventions utilized to manage and treat postpartum hemorrhage is presented and organized into a basic algorithm. CONCLUSION The manuscript should promote and facilitate a more educated, systematic and effective surgeon response and participation in the management of postpartum hemorrhage.
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Affiliation(s)
| | - Forest R Sheppard
- Department of Surgery, National Naval Medical Center, Bethesda, MD, USA
- Department of Surgery, Uniformed Services University, Bethesda, MD, USA
- Regenerative Medicine, Naval Medical Research Center, Silver Spring, MD, USA
| | - Mildred R Chernofsky
- Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, DC, USA
| | | | - Frederick Gage
- Department of Surgery, National Naval Medical Center, Bethesda, MD, USA
- Regenerative Medicine, Naval Medical Research Center, Silver Spring, MD, USA
| | - Gary Wind
- Department of Surgery, National Naval Medical Center, Bethesda, MD, USA
- Department of Surgery, Uniformed Services University, Bethesda, MD, USA
| | - Eric A Elster
- Department of Surgery, National Naval Medical Center, Bethesda, MD, USA
- Department of Surgery, Uniformed Services University, Bethesda, MD, USA
- Regenerative Medicine, Naval Medical Research Center, Silver Spring, MD, USA
| | - William A Liston
- Department of Surgery, National Naval Medical Center, Bethesda, MD, USA
- Department of Surgery, Uniformed Services University, Bethesda, MD, USA
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El-Hamamy E, B-Lynch C. A worldwide review of the uses of the uterine compression suture techniques as alternative to hysterectomy in the management of severe post-partum haemorrhage. J OBSTET GYNAECOL 2009; 25:143-9. [PMID: 15814393 DOI: 10.1080/01443610500040752] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Postpartum haemorrhage (PPH) is a worldwide problem. The historical background dates back to William Smelley's in the seventeenth century in his famous treaty of the theory and practice of midwifery in 1752. Changes in clinical factors and surgical expertise compel the modern day midwife and obstetrician to be vigilant in identifying risk factors and apply appropriate solution early. The recent confidential enquiry into maternal death (why mothers die (2000-2002)) identifies areas of substandard care. The rising caesarean section rate adds to the rising incidence of PPH. The reduction in junior doctor's hours may limit the pool of experienced obstetric surgeons available to manage severe PPH competently. There can be major complications following radical surgery for PPH. These include loss of fertility, other morbidity and even maternal death. The invention of the B-Lynch surgical technique for the conservative management of PPH was first performed and reported by a consultant obstetrician and gynaecological surgeon in Milton Keynes NHS Trust publishing the first series of cases in BJOG 1997. This has made a significant impact on the conservative surgical management of massive PPH. There are now over 1300 successful applications of this technique worldwide (CB-Lynch personal communication). Other similar or modified techniques such as Cho's Square Suture and Haymen's modification of the B-Lynch Suture Technique have been introduced adding to more available methods of conservative surgery. The current list of publications of successful application of the B-Lynch compression technique is encouraging and more outcome data can be reported by a letter or e-mail to enquiries@cblynch.com. Obstetricians and midwives both in developed and underdeveloped countries should seek training and attend fire drills in PPH control to avoid maternal morbidity and death. There should be special concentration on effective conservative surgery such as uterine compression techniques to avoid major morbidity and loss of fertility.
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Affiliation(s)
- E El-Hamamy
- St George's Hospital Medical School, London, UK.
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Abstract
We describe 2 cases of uterine compression suture without hysterotomy, only described once in the literature previously (Hayman et al. 2002). We consider in detail the suture material used for this technique and show photos of the compression suture at laparoscopy 4 weeks after insertion to demonstrate why it is inappropriate to use a non-absorbable suture. Modified compression sutures are being used increasingly and a wide variety of suture materials are being chosen, including vicryl, PDS and nylon (verbal communications). We feel it important to report our findings so that others can avoid the use of non or slowly absorbable sutures.
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Affiliation(s)
- C Cotzias
- Chelsea and Westminster Hospital, 369 Fulham Road, London SW10, UK.
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Malvino E, Eisele G, Martínez M, Firpo J, Lowenstein R. Resultados en relación con la prevención y el tratamiento actual de las hemorragias obstétricas graves secundarias a atonías uterinas y acretismos placentarios. Clínica e Investigación en Ginecología y Obstetricia 2009; 36:49-54. [DOI: 10.1016/j.gine.2008.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Doumouchtsis SK, Papageorghiou AT, Arulkumaran S. Systematic Review of Conservative Management of Postpartum Hemorrhage: What to Do When Medical Treatment Fails. Obstet Gynecol Surv 2007; 62:540-7. [PMID: 17634155 DOI: 10.1097/01.ogx.0000271137.81361.93] [Citation(s) in RCA: 250] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We performed a systematic review to identify all studies evaluating the success rates of treatment of major postpartum hemorrhage by uterine balloon tamponade, uterine compression sutures, pelvic devascularization, and arterial embolization. We included studies reporting on at least 5 cases. All searches were performed independently by 2 researchers and updated in June 2006. Failure of management was defined as the need to proceed to subsequent or repeat surgical or radiological therapy or hysterectomy, or death. As the search identified no randomized controlled trials, we proceeded to search for observational studies. This identified 396 publications, and after exclusions, 46 studies were included in the systematic review. The cumulative outcomes showed success rates of 90.7% (95% confidence interval [CI], 85.7%-94.0%) for arterial embolization, 84.0% (95% CI, 77.5%-88.8%) for balloon tamponade, 91.7% (95% CI, 84.9%-95.5%) for uterine compression sutures, and 84.6% (81.2%-87.5%) for iliac artery ligation or uterine devascularization (P = 0.06). At present there is no evidence to suggest that any one method is better for the management of severe postpartum hemorrhage. Randomized controlled trials of the various treatment options may be difficult to perform in practice. As balloon tamponade is the least invasive and most rapid approach, it would be logical to use this as the first step in the management.
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Affiliation(s)
- Stergios K Doumouchtsis
- Department of Obstetrics and Gynaecology, St George's, University of London, London, United Kingdom
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Sparić R, Dokić M, Argirović R, Kadija S, Bogdanović Z, Milenković V. Incidence of postpartum post-cesarean hysterectomy at the Institute of gynecology and obstetrics, Clinical center of Serbia, Belgrade. SRP ARK CELOK LEK 2007; 135:160-2. [PMID: 17642454 DOI: 10.2298/sarh0704160s] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. Postpartum hysterectomy means hysterectomy at least 6 weeks after delivery or cesarean section. It is usually performed in life-threatening situations. Incidence of postpartum hysterectomy varies from 0.02% to 0.3% of total number of deliveries. Objective. The aim of this study was to show and compare the incidence of postpartum hysterectomy after the cesarean section at the Institute of Gynecology and Obstetrics, Clinical Center of Serbia. We compared two five-year periods: the first period 1987-1982 and the second 2000-2004. Method. The retrospective study analyzed all patients treated at the Institute of Gynecology and Obstetrics who had had hysterectomy until six weeks after vaginal delivery or cesarean section. We analyzed the number of deliveries and the number of postpartum hysterectomies. Results. There were 50,467 deliveries (3,542 cesarean sections) and 91 postpartum hysterectomies (70 or 76.92% after cesarean section) in the first period. In the second period, there were 34,035 deliveries (7,105 cesarean sections) and 64 hysterectomies (39 or 60.94 % after cesarean section). The overall incidence of postpartum hysterectomy was 1.98/1,000 in the first and 1.88/1,000 deliveries in the second period. The incidence of post-cesarean hysterectomy decreased from 19.76/1,000 in the first period to 5.49/1,000 in the second period. Conclusion. It is crucial for each obstetrician to cautiously distinguish and reach an appropriate decision about the exact indications for cesarean delivery having in mind growing incidence of cesarean sections, which is the main risk factor for puerperal morbidity and mortality. .
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Habek D, Vranjes M, Bobić Vuković M, Valetić J, Krcmar V, Simunac J. Successful Term Pregnancy after B-Lynch Compression Suture in a Previous Pregnancy on Account of Massive Primary Postpartum Hemorrhage. Fetal Diagn Ther 2006; 21:475-6. [PMID: 16912499 DOI: 10.1159/000093892] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2005] [Accepted: 12/06/2005] [Indexed: 11/19/2022]
Abstract
A case is presented of a successful term pregnancy in a 28-year-old secundipara after previous Misgav-Ladach cesarean section and B-Lynch compression suture on account of massive postpartal hemorrhage caused by uterine atony. On account of dystocia and relative cephalopelvic disproportion, secondary repeated cesarean section was performed; she gave birth to a live child 3,900 g/52 cm, Apgar score 9/10, with a regular neonatal course. During the repeated cesarean section, thin laces of connective tissue were found along the sutures placed on the uterus during the previous B-Lynch operation. Pelvic and intrauterine adhesions were not found.
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Affiliation(s)
- Dubravko Habek
- Department of Obstetrics and Gynecology, General Hospital Sveti Duh, Zagreb, Croatia.
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Habek D, Kulas T, Bobić-Vuković M, Selthofer R, Vujić B, Ugljarević M. Successful of the B-Lynch compression suture in the management of massive postpartum hemorrhage: case reports and review. Arch Gynecol Obstet 2005; 273:307-9. [PMID: 16208483 DOI: 10.1007/s00404-005-0059-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2005] [Accepted: 07/12/2005] [Indexed: 10/25/2022]
Abstract
The authors describe three patients who developed massive primary postpartum hemorrhage and review the case reports. In two patients, primary postpartum hemorrhage was due to uterine atony, and in one patient it was due to atony and thrombophilia. In all three patients, excellent effect was achieved with hemorrhage reduction by a compression B-Lynch suture alone, with bimanual compression following medicamentous uterotonic therapy. B-Lynch suture is an efficient, safe, and simple method for the treatment of primary postpartum hemorrhage during cesarean section, which successfully reduces the number of urgent postpartum hysterectomies, also preserving subsequent fertility. In our opinion, the method should be included in the algorithm of primary postpartum hemorrhage management at all obstetric departments.
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Affiliation(s)
- Dubravko Habek
- Department of Obstetrics, Osijek University Hospital, J. Huttlera 4, 31000, Osijek, Croatia.
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Abstract
OBJECTIVE To report a case of successful pregnancy after hypogastric artery ligation and the B-Lynch brace suturing technique. DESIGN Case report. SETTING Education and research hospital. PATIENT(S) A 22-year-old woman, whose first pregnancy was terminated by cesarean section owing to abruptio placenta and intrauterine fetal demise diagnosed at the 26th week of gestation, referred to our clinic for uterine atony. INTERVENTION(S) Hypogastric artery ligation and the B-Lynch brace suturing technique. MAIN OUTCOME MEASURE(S) Clinical pregnancy and live birth. RESULT(S) Two years after the surgery, the patient conceived spontaneously and delivered a healthy infant after an uneventful pregnancy. CONCLUSION(S) This is the first reported case of successful pregnancy after hypogastric artery ligation and B-Lynch suturing technique. This life-saving therapeutic option for severe postpartum hemorrhage appears to be a safe procedure that does not impair subsequent fertility and pregnancy outcomes. The B-Lynch suturing technique seems to be simple and has the capability of preserving the uterus; therefore it may be considered as the first-line surgical treatment for uterine atony before considering hysterectomy.
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Affiliation(s)
- Murat Api
- Department of Obstetrics and Gynecology, Haseki Education and Research Hospital, Istanbul, Turkey.
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Affiliation(s)
- Muge Harma
- Department of Gynecology and Obstetrics, Radiology University of Harran, Sanliurfa, Turkey.
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