Abstract: Preamble: The prevalence of postpartum haemorrhage varies widely from 2-10% globally. It is generally around 6% of all deliveries. Postpartum haemorrhage is defined as the loss of more than 500mls of blood after a vaginal delivery or more than 1,000mls after a caesarean section. The prevalence of PPH varies depending on geographic location, healthcare access and risk factors, such as multiple pregnancies, Postpartum haemorrhage (PPH) remains one of the leading causes of maternal morbidity and mortality worldwide. The B-Lynch suture technique developed to manage PPH due to uterine atony has gained prominence as a valuable surgical intervention over the years since its invention. The original procedure by B-Lynch had success rate of 80-100% in controlling PPH due to atony. Whenever B-Lynch suture fails, obstetricians tend to resort to hysterectomy therefore introducing modifications that can improve the success rate of B-Lynch suture is worthwhile.
The possibility of slippage of the B-Lynch suture has been well documented and published for example, by Marasinghe JP et al. The application of an anchor suture at the fundal summit of the B-Lynch suture is an innovation to prevent the slippage of the B-Lynch braces which is capable of reversing the effect of the compression. The main author particularly experienced this in a case of postpartum haemorrhage in which a B-Lynch suture was applied but unfortunately, the patient started bleeding again after surgery necessitating return to opening the patient up at which both brace sutures were found to have slipped down the sides of the uterus. The incidence stimulated the thought and search for what could be done as modification to the B-Lynch suture to prevent such occurrence.
Materials and Method: The case series is that of five patients managed for postpartum haemorrhage due to uterine atony during caesarean section despite administration of the usual uterotonics. All the patients developed atony of the uterus at caesarean section that was associated with bleeding necessitating insertion of B-Lynch suture. The possibility of failure of the B-Lynch suture was reduced by anchoring the 2 braces at their fundal summit. The original B-Lynch suture is first inserted using a vicryl 2 suture. A vicryl number 1 or 2 is then passed with small bite under the brace suture at the fundal summit of the brace on either side and tied with 2 or 3 knots in the middle. The patients were then closely followed up over 24 hours after surgery for any signs of abdominal distension and bleeding per vagina
Results: All the patients so managed and monitored (100.0%) did very well without any incidence of bleeding from the vaginal or abdominal distension over the 24 hours post operative period and till discharge on record time. None of them (0.0%) required any additional postpartum haemorrhage preventive of therapeutic intervention throughout their postoperative period stay in the hospital.
Conclusion: The original procedure by B-Lynch had success rate of 80-100% in controlling PPH due to atony. The addition of fundal brace anchor as described in this case series will definitely go a long way in reducing the percentages of failure associated with B-Lynch suture and therefore contribute to prevention of maternal mortality due to postpartum haemorrhage.
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