1. 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.

2. 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

3. CAUSES OF PPH FOUR “ T”s BUT MOST IMPORTANT IS
TONE — MULTIPARA, MANIPULATION,
OVER DISTENTION, PROLONGED LABOUR,
DRUGS-SEDATION, OXYTOCIN, ABRUPTION,
MALFORMATION,INVERSION.

4. WHEN MEDICAL MANAGAMENT FAILS
SURGICAL MANAGEMENT
Uterus conserving : NEED OF TIME
Definitive - Hysterectomy

5. 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

6. 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 at Dr. D.Y.Patil Medical college

7. - 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

8. 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

10. COMPLICATIONS NIL - IF DONE PROPERLY TOO TIGHT COMPRESSION --
CUT THROUGH STITCH
UTERINE NECROSIS
INTRAPERITONEAL BLEED

11. 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

12. 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%)

13. 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%)

14. OTHER COMPRESSION SUTURES
Hayman Uterine Compression Suture
Cho’s Multiple Square Suture
Global Stitch By
Dr. Gunasheela Bangalore

15. 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.

16. TO HELP WHERE THE LIFE BEGINS, WE STAND WITH THE WOMEN, BY SIDE OF THE WOMEN AND BEHIND HER
THANK YOU