The B-Lynch surgical technique for control of postpartum haemorrhage

Dear Sir,

Death from postpartum haemorrhage (PPH) occurs in approximately 1 per 1,000 deliveries (Mousa and Alffirevic 2003). Uterine atony accounts for 75–90% of primary PPH (Mousa and Alffirevic 2003). There is a variety of acceptable methods of treatment, such as simple bi-manual compression, oxytocic drugs such as oxytocin, ergometrine, and prostaglandins which are safe and effective, but occasionally prove inadequate or unsatisfactory. Different uterine compression sutures have been described to control PPH, including a suture that runs through the full thickness of both the anterior and posterior uterine walls. Christopher B-Lynch was the first to highlight this technique (B-Lynch et al. 1997). The procedure was first performed in 1989 in a patient who was experiencing massive PPH but refused hysterectomy. The suture aims to exert continuous vertical vascular compression (B-Lynch et al. 1997). This technique offers the advantages of simplicity of application, uterus-saving potential, and its capacity for preserving the uterus and therefore, patient fertility, and thus it should be considered in cases of severe atonic PPH when oxytocic agents fail, and before resorting to hysterectomy. In spite of this, little literature concerning the B-Lynch suture technique exist and most of these are case reports. We reviewed the medical files of 37 women who underwent B-Lynch suture for atonic PPH in the Wad Madani Teaching Hospital, Sudan, during the period February 2006 to December 2008. In 29 (78.38%) of the 37 cases (86.7%), PPH occurred after caesarean deliveries.

The hysterotomy incision was reopened in cases of caesarean deliveries, or laparotomy was performed in cases of vaginal deliveries, and a B-Lynch suture was placed as previously described (B-Lynch et al. 1997). The suture material used was Vicryl. Haemostasis was obtained after this procedure, and the abdomen was closed. Blood loss was estimated at 2,000–3,000 ml, and all patients received a transfusion of blood and fresh frozen plasma. B-Lynch sutures controlled the haemorrhage and resulted in an avoidance of hysterectomy in all these patients and their postpartum period was uneventful. This may be the largest published number of patient series who underwent the B-Lynch suture technique for PPH and there was a high success rate in these women. However, some complications/failures were reported, e.g. one case of hysterectomy was required due to pyometra in an ischaemic uterus (Sentilhes et al. 2008). Obstetricians, especially in underdeveloped countries, should be trained and attend drills in PPH control to avoid maternal morbidity and death related to PPH.

Editor's Note: For a recent review on this subject see: El-Hamamy E, Wright A, B-Lynch C. 2009. The B-Lynch suture technique for postpartum haemorrhage: A decade of experience and outcome. Journal of Obstetrics and Gynaecology 29:278–283.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.