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!
Now as a next step, we ask what could be done to lower the costs of the implementation of the E-MOTIVE bundle? The most obvious answer is to consider displacing the tens of thousands of disposable plastic drapes with a purpose-built reusable device.
Fortunately one of the obstetricians involved in the E-MOTIVE study, Dr. Justus Hofmeyr, had been innovating around this very issue, designing a tray with wells that could fit under a woman’s buttocks, collect and accurately measure the. blood. This tray, theMaternaWellTraywas conceived as a device that could be sterilized and reused, and is manufactured in South Africa by Umoya.
The Pumani bubbleCPAP was designed to meet this need for Malawi and is now widely available through Maternova. We had a few questions about post-research phases of the Pumani bubbleCPAP which we posed to Jocelyn Brown, inventor of the Pumani bubbleCPAP, and Molly McCabe, Director of Product Management.