Modification of Christopher Balogun – Lynch Stitch in Preventing Post Partum Hemorrhage Dr. Sanchita Karmakar (Resident) Dr. Hemant Deshpande (Prof & HOD of OBGY) Dr. D.Y.Patil Medical College, Pimpri, Pune.
Postpartum Hemorrhage Blood loss > 500 ml at vaginal delivery > 1000 ml at Cesarean ACOG 10% drop in hematocrit Need for blood transfusion Severe PPH > 1000 ml loss at vaginal delivery Any amount of blood loss causes S/O Hypovolemic Hemorrhagic Shock - Tachycardia - Hypotension - Reduced urine out put
CAUSES OF PPH FOUR “ T”s BUT MOST IMPORTANT IS TONE — MULTIPARA, MANIPULATION, OVER DISTENTION, PROLONGED LABOUR, DRUGS-SEDATION, OXYTOCIN, ABRUPTION, MALFORMATION,INVERSION.
WHEN MEDICAL MANAGAMENT FAILS SURGICAL MANAGEMENT Uterus conserving : NEED OF TIME Definitive - Hysterectomy
CHRISTOPHER BALOGUN-LYNCH In 1997 he published a description of the B-Lynch Brace suture for post partum hemorrhage His Excellency of the President conferred the honor of “Grand Officer Of the Republic of Sierra Leone” in recognition of profound contribution in the area of obstetrics B-Lynch Procedure
Aims & Objectives: To evaluate effectiveness of modified B-Lynch suture in controlling atonic PPH. Material & method: This is a study of 18 cases of PPH managed by Modified B – Lynch Stitch by Dr. Hemant Deshpande from 1st January 2001 to 31st December 2009 at Dr. D.Y.Patil Medical college
- BY DR. HEMANT DESHPANDE MOD. CHRISTOPHER B LYNCH STITCH - BY DR. HEMANT DESHPANDE Symmetrical Anchoring stitches at 3 places on uterus Ant wall – Fundus ---- Post wall CAT GUT 1 OR 2 NO NO SLIPAGE OF STITCH MODEST SYMMETRICAL COMPRESSION NO UNEVEN COMPRESSION NO RISK OF GANGRENE OF UTERUS MECHANICAL STIMULATION
PREREQUISITES G.A CATHETERISATION LOWER UTERINE SEGMANT OPENED DIGITALLY EXPLORE UTERUS ASSESS EFFICACY OF M.B.L STITCH CONFIRM EMPTY UTERUS BIMANUAL COMPRESSION NO BLEEDING PT WILL RESPOND TO CBS
COMPLICATIONS NIL - IF DONE PROPERLY TOO TIGHT COMPRESSION -- CUT THROUGH STITCH UTERINE NECROSIS INTRAPERITONEAL BLEED
OUR EXPERIENCE 18 CASES OF ATONIC PPH MANAGED BY MOD. CHRISTOPHER B LYNCH STITCH IN LAST 10 YRS 3 LSCS & 15 FTND ATONIC PPH MAINLY DUE TO MULTIPARITY & PROLONGED LABOUR
RESULTS 16 CASES (89%) RESPONDED WELL WITHOUT ANY COMPLICATIONS BLOOD TRANSFUSION WAS GIVEN IN 16 PATIENTS (89%) 2 REQUIRED INTERNAL ILLIAC ARTERY LIGATION (11%) TUBAL LIGATION IN 9 CASES(50%)
RESULTS ON FOLLOW UP FOLLOW UP USG AFTER 6 WKS SHOWING NORMAL UTERINE CONTOUR & ANATOMY IN ALL CASES ON LONG TERM FOLLOW UP – - NO MENSTRUAL IRREGULARITY - 7 PTS CONCIEVED AGAIN & DELIVERED WITHOUT ANY COMPLICATIONS(78%)
OTHER COMPRESSION SUTURES Hayman Uterine Compression Suture Cho’s Multiple Square Suture Global Stitch By Dr. Gunasheela Bangalore
CONCLUSION Modified B-Lynch technique is an effective uterus conserving procedure with a relatively low morbidity to control severe PPH without hampering future fertility. Uterine compression sutures if done correctly and timely ,have replaced uterine artery ligation, hypogastric artery ligation & postpartum hysterectomy to a greater extent for the surgical treatment of uterine atony.
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