1Associate Professor, Department of Obstetrics & Gynecology, Hassan Institute of Medical Sciences, Hassan, Karnataka, India
2Professor, Department of Obstetrics & Gynecology, JJM Medical College, Davanagere, Karnataka, India
*Corresponding author: Girija B S, Associate Professor, Department of OBG, Hassan Institute of Medical Sciences, Hassan, Karnataka, India. Mobile No. 9945462077, E-mail: girijadotrada@yahoo.com
Online published on 23 January, 2014.
Department of Obstetrics & Gynecology, JJM Medical College Davanagere & Hassan Institute of Medical Sciences, Hassan, Karnataka, India.
Atonic postpartum haemorrhage during caesarian delivery which was not controlled with oxytocics were managed with conservative procedures like Bilateral uterine artery ligation & modified B-lynch brace suture application. Outcome of the procedure in terms of control of PPH, post operative complications & subsequent reproductive health outcome were studied.
The paper explains the combined approach of uterine artery ligation along with modified B-lynch brace suture application in atonic uterus during caesarian section when medical measures failed. Since uterine atony is the main reason for excessive & uncontrollable haemorrhage after child birth, need to perform such surgery is rather common. Combined approach is more effective in controlling atonic PPH.
Out of 25 cases in the study group, which were managed by conservative surgical procedure like Bilateral uterine artery ligation & modified B-lynch brace suture application for atonic PPH following caesarian delivery, 24(96%) had control of PPH, 1(4%) case had failure of the procedure & ended with hysterectomy due to cardiovascular instability. Postoperatively there were no complications & there was normal involution of the uterus. Out of 25 cases, 12(48%) cases attempted conception, 4(33%) of them conceived. 2 of them had repeat LSCS during which no uterine cavity abnormality was found. Other 2 had vaginal birth after caesarian section.5 cases underwent tubal ligation along with caesarian section. 8 patients were lost for follow up. Out of 17 cases followed up, none of them had menstrual abnormality.
Atonic PPH not responding to medical line of treatment can be effectively controlled with judicious & timely application of conservative combined approach like bilateral uterine artery ligation & modified B-lynch brace suture application. This procedure is easy to perform, which can avoid peripartum hysterectomy & retain the uterus for future fertility & menstrual function.
PPH Conservative Management, B-Lynch Technique
