Outcome of woman with a b-lynch compression suture at Chris Hani Baragwanath academic hospital

Abstract

Background Obstetric haemorrhage is the leading cause of maternal death particularly in Sub-Saharan Africa, and post-partum haemorrhage from uterine atony is the leading cause of deaths from obstetric haemorrhage. Post-partum haemorrhage is therefore a major cause of maternal mortality, and the B-Lynch compression suture is a reliable and safe surgical method to manage post-partum haemorrhage... This study aims to analyse the rate of use of B-Lynch sutures in a select South African setting, as well as its observed risk factors and the outcomes of women who had a B-Lynch suture for PPH.

Methods The method used to carry out this study was a retrospective audit of women with a blood loss of 1000mls or more at Caesarean Section, and who required a B-Lynch suture. This was done at the Chris Hani Baragwanath Academic Hospital.

Results According to the retrospective audit, fifty-seven women had a B-Lynch compression suture during Caesarean Section with a success rate of 98%. Ages of these women were within the range of 17 and 42 years, with a mean of 28 ± 5.7. Thirty-nine percent (39%) of the women were obese, while 47% of the women were anaemic. One woman had pre-eclampsia, and none had gestational diabetes. Nine percent (9%) of the women were induced, while 18% received augmentation with uterotonics. The average blood loss was 1291±411ml. The shock index in theatre was in the range of 0.54 to1.26, while the shock index in recovery was in the range of 0.4 to 1.4. All women had a B-Lynch for uterine atony after failure of medical management. One woman required systemic devascularisation and a hysterectomy to arrest the haemorrhage. One death was recorded. Ninety-three percent (93%) of deliveries were singletons.

Conclusion The B-Lynch compression suture in women who had PPH from uterine atony had a very high success rate, and was associated with few complications. B-Lynch can therefore be considered a life-saving technique that has improved maternal outcomes, even when employed in poorly resourced settings.