EFFECTIVENESS OF B-LYNCH IN PRIMARY POSTPARTUM HEMORRHAGE DUE TO UTERINE ATONY

Authors

  • Lala Rukh Khyber Teaching Hospital, Peshawar, Pakistan. Author
  • Naila Qurat ul Ain Fayaz Bukhari Khyber Teaching Hospital, Peshawar, Pakistan. Author

DOI:

https://doi.org/10.71000/3bx9e816

Keywords:

B-Lynch suture, postpartum hemorrhage, uterine atony, hemostasis, , maternal morbidity, fertility preservation, surgical management, , uterine atony.

Abstract

Background: Postpartum hemorrhage (PPH) remains one of the most critical causes of maternal morbidity and mortality worldwide, with uterine atony being its most common underlying cause. Prompt and effective management is crucial to reduce complications and preserve reproductive potential. The B-Lynch suture, a uterus-sparing surgical technique, offers a mechanical approach to control bleeding when medical interventions fail, especially in low-resource settings where hysterectomy may not be feasible or desirable.

Objective: To determine the effectiveness of the B-Lynch suture technique in controlling primary postpartum hemorrhage due to uterine atony.

Methods: This quasi-experimental study was conducted in the Department of Obstetrics and Gynecology at Khyber Teaching Hospital, Peshawar, from May 16 to November 16, 2024. A total of 151 postpartum women aged 18 to 40 years were enrolled using consecutive non-probability sampling. All participants were diagnosed with uterine atony-induced PPH, defined as blood loss exceeding 500 mL within the first 24 hours of delivery. The B-Lynch suture was applied using chromic catgut No. 2 under supervision of a consultant obstetrician. Hemostasis was assessed 12 hours post-procedure. SPSS version 25 was used for data analysis, and chi-square testing assessed associations at a significance level of p<0.05.

Results: The mean age of participants was 27.28 ± 5.85 years, mean BMI was 25.18 ± 1.45 kg/m², and mean gestational age was 38.11 ± 2.05 weeks. Hemostasis was successfully achieved in 120 out of 151 patients, yielding an overall effectiveness rate of 79.5%. No major complications were reported, and all women retained uterine integrity.

Conclusion: The B-Lynch suture is a highly effective, fertility-preserving intervention for managing primary PPH due to uterine atony and should be incorporated into routine obstetric practice, particularly in resource-constrained environments.

Author Biographies

  • Lala Rukh, Khyber Teaching Hospital, Peshawar, Pakistan.

    Trainee Medical Officer, Department of Obstetrics and Gynecology, Khyber Teaching Hospital, Peshawar, Pakistan.

  • Naila Qurat ul Ain Fayaz Bukhari, Khyber Teaching Hospital, Peshawar, Pakistan.

    Assistant professor, Department of Obstetrics and Gynecology, Khyber Teaching Hospital, Peshawar, Pakistan.

References

Yang J, Pan X, Garfield RE, Liu H. Uterine electromyography (EMG) measurements to predict preterm caesarean section in patients with complete placenta previa. J Obstet Gynaecol. 2021;41(4):532-5.

Sichitiu J, Meuwly JY, Baud D, Desseauve D. Using shear wave elastography to assess uterine tonicity after vaginal delivery. Sci Rep. 2021;11(1):10420.

Cherepanov SM, Yuhi T, Iizuka T, Hosono T, Ono M, Fujiwara H, et al. Two oxytocin analogs, N-(p-fluorobenzyl) glycine and N-(3-hydroxypropyl) glycine, induce uterine contractions ex vivo in ways that differ from that of oxytocin. PLoS One. 2023;18(2):e0281363.

Larcin L, Karakaya G, Rygaert X, Van Wilder P, Lamy C, Demyttenaere B, et al. Trends and regional variations in prescriptions dispensed to stimulate uterine contractions at the end of pregnancy in Belgium: A community-based study from 2003 to 2018. Pharmacoepidemiol Drug Saf. 2023;32(2):216-24.

Balogun RO, Lawal OO, Bello YO, Odedele TM, Morhason-Bello IO, Oladokun A. A randomized controlled trial on the comparison of two doses of carbetocin with oxytocin for the prevention of postpartum hemorrhage (concert trial). J Obstet Gynaecol Res. 2024;50(11):2046-56.

Frenken MWE, van der Woude DAA, van Willigen BG, Dieleman JP, Oei SG, van Laar J. A positive association between postpartum electrohysterography parameters and blood loss after vaginal delivery: A prospective study. Placenta. 2025;160:11-9.

Wray S, Arrowsmith S, Sharp A. Pharmacological Interventions in Labor and Delivery. Annu Rev Pharmacol Toxicol. 2023;63:471-89.

Peska E, Balki M, Maxwell C, Ye XY, Downey K, Carvalho JCA. Oxytocin at elective caesarean delivery: a dose-finding study in women with obesity. Anaesthesia. 2021;76(7):918-23.

Yi C, Li K, Shi Q. Meta-analysis of the effect of duration of labour on postpartum haemorrhage. Ginekol Pol. 2024;95(5):391-7.

Liu J, Wang C, Yan R, Lu Y, Bai J, Wang H, et al. Machine learning-based prediction of postpartum hemorrhage after vaginal delivery: combining bleeding high risk factors and uterine contraction curve. Arch Gynecol Obstet. 2022;306(4):1015-25.

Raguramane S, Mishra SK, Jha N, Parida S, Jha AK. Effect of phenylephrine infusion on postpartum blood loss after cesarean delivery: a placebo-controlled, randomized clinical trial. Am J Obstet Gynecol MFM. 2025;7(2):101593.

Wei D, Wang Z, Yue J, Chen Y, Meng J, Niu X. Effect of low-intensity focused ultrasound therapy on postpartum uterine involution in puerperal women: A randomized controlled trial. PLoS One. 2024;19(4):e0301825.

Cochrane E, Huber A, Jou C, Chappelle J. The effect of an oxytocin washout period on blood loss at cesarean delivery. J Perinat Med. 2020;48(8):799-802.

Pérez-Jiménez JM, Luque-Oliveros M, Gonzalez-Perez D, Rivera-Sequeiros A, Rodriguez-Blanco C. Does immediate skin-to-skin contact at caesarean sections promote uterine contraction and recovery of the maternal blood haemoglobin levels? A randomized clinical trial. Nurs Open. 2023;10(2):649-57.

Thijssen KMJ, van den Broek MJM, Koenraads FA, Cantineau-Goedegebuure JI, Papatsonis DNM, van Willigen BG, et al. Detection of postpartum uterine activity with electrohysterography. Eur J Obstet Gynecol Reprod Biol. 2023;291:23-8.

Blitz MJ, Yukhayev A, Pachtman SL, Reisner J, Moses D, Sison CP, et al. Twin pregnancy and risk of postpartum hemorrhage. J Matern Fetal Neonatal Med. 2020;33(22):3740-5.

Jun-Yu P, Ling W, Kai-Feng L, Sheng-Yun X. Importance of Factors Affecting Uterine Atony: Analysis Based on Neural Networks. Med Discoveries. 2024;3(12):1229.

Jena BH, Biks GA, Gete YK, Gelaye KA. Determinants of postpartum uterine atony in urban South Ethiopia: a community-based unmatched nested case–control study. BMC Pregnancy Childbirth. 2023;23(1):499.

Warade S, Sharma N. A prospective study of B-Lynch suture in the management of atonic PPH at tertiary care centre. Indian J Obstet Gynecol Res. 2020;7(2):173–6.

Zaheen Z, Akhter R, Khalid M, Sahito RM, Rekha, Joyo Y. Effectiveness of B-lynch suture technique for treatment of high-risk women for postpartum haemorrhage at Liaquat Medical University hospital Hyderabad. Professional Med J. 2020;27(3):523–9.

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Published

2025-06-10