Sometimes, the answer to severe hemorrhage turns out to be not a device or gadget, but an innovative surgical technique--in this case the B-Lynch suture.
Over 100,000 women die of postpartum hemorrhage (PPH) each year, accounting for 35% of all maternal deaths. An estimated 90% of these cases are caused when the uterus is unable to adequately contract after childbirth (uterine atony).
When “conservative management” using massage, pressure packing and drugs such as oxytocin or misoprostol fail to stop severe bleeding, healthcare providers must often resort to radical surgical intervention, including hysterectomy (the removal of the uterus). In addition to loss of fertility, these interventions can cause a range of complications and even death.
In attempt to avoid hysterectomy, Christopher Balogun-Lynch developed an innovative surgical technique to treat atonic PPH. Using this method, a continuous suture is used to envelop and mechanically compress the uterus. Since its invention in 1997, the B-Lynch technique has been used successfully in approximately 1,300 cases worldwide.
For example, in a review of PPH cases in Pakistan, authors favored the B-Lynch technique for its safety, simplicity, lifesaving potential and ability to preserve fertility. The suture was successful for cases of PPH after both vaginal and caesarian deliveries. As a result, the authors believe the B-Lynch suture “should be considered as a first line surgical treatment before…hysterectomy”.
In Singapore, one study indicated that out of 5,470 deliveries, 100 women experienced PPH. Only seven of these women were treated with the B-Lynch suture, successfully avoiding hysterectomy in five cases. The authors thus conclude that the B-Lynch technique is an effective procedure for managing PPH before any radical surgery is considered. “It has the advantage of being applied easily and rapidly, and should be taught to all trainees and registrars in obstetrics,” they argue.
Since 1997, several modifications of the B-Lynch method have been developed, for which there is a growing body of supportive evidence. We're curious to know how standard the teaching of the B-lynch suture is in the training of obstetrician/gynecologists and others in Africa, Asia and Latin America.
We hope it goes without saying that this is a procedure meant for surgeons! Don't try this at home!
Identification of anemia in pregnant women is important, since it is an important cause of multiple complications during pregnancy (preterm delivery, low birth weight and perinatal death), so it is recommended to all pregnant women, in the first prenatal visit and at 28 weeks of gestation, the measurement of serum concentrations of hemoglobin and hematocrit as a screening test for anemia.
Prenatal assessment seeks to identify, through clinical history, sociodemographic characteristics, mean blood pressure, Doppler of the uterine arteries and biochemical markers such as pregnancy-associated plasma protein A (PAPP-A) and placental growth factor (PlGF), those women who are at high risk of developing preeclampsia in order to take appropriate measures. that can help reduce that risk.