stitch in time, saves life; should B-Lynch suture be the first line surgical option for control of massive primary PPH due to refractory uterine atony? An experience at D.H.Q Hospital Faisalabad

Objective: to see the effectiveness of B-Lynch brace suture as first line surgical option to control massive primary postpartum hemorrhage due to uterine atony refractory to medical treatment

Study Design: quasi experimental

Place and duration of study: this research work was done in D.H.Q Hospital Faisalabad from 2002-2004. During the study period 21 women underwent B-Lynch Brace suture to halt bleeding resulting from refractory uterine atony. Data was collected in prospective manner on a specialized proforma from attending house officers and postgraduate trainee registrars. The B-Lynch technique was used. Postoperatively the patients were kept in high dependency area within labor room for 24-48 hours. Follow up was done in O.P.D after discharge

Materials and Methods: the women who had severe/ persistent primary postpartum hemorrhage due to uterine atony were initially resuscitated and simultaneously managed with ecbolics as per unit protocol [i-e; 40 units oxytocin in 1000cc Normal Saline infusion, inj. methergen [withheld women with specific contraindications for methergen], inj. F2 alpha in each uterine cornu, and per rectal misoprostol. However those women who remained unresponsive to the medical treatment, underwent B-Lynch Brace suture as first line surgical option

Results: the success rate was 85.7% [n18] in terms of control of hemorrhage and hysterectomy was averted in 95% [n20] of women. Whereas in two women it needed to be integrated with stepwise uterine de-vascularization procedures

Conclusion: B-Lynch suture is effective as first line surgical option to arrest postpartum hemorrhage due to refractory atonic uterus

Abdominal sacrohysteropexy in young women with uterovaginal prolapse

Objective: To study the results of sacrohysteropexywith Prolene Mesh for treatment of uterovaginalprolapse in women who desire to preserve theiruterus

Study Design: Prospective observationalstudy

Place and duration of study: This study wascarried out in Allied Hospital, Faisalabad over aperiod of one year from April 2010 to April 2011

Methods: 12 women with uterovaginal prolapsewishing to retain their uterus underwentSacrohysteropexy with Prolene Mesh attached touterine isthmus and to the anterior longitudinalligament of the first or second sacral vertebra in atension free fashion. Subjective and objective cureof uterine prolapse and operative and postoperativecomplications were noted

Results: 12 patientsunderwent Sacrohysteropexy for uterovaginalprolapse during this study period. The mean age ofpatient was 30 years [range 16-40 years]. Ten[83.3%] were multipara while two [16.7%] werenullipara. All women had second degreeuterovaginal prolapse. The mean follow up periodwas 12 months. No women developed intra andpostoperative complications. No single case of mesherosion was detected success rate was 83.3%.Recurrent prolapse was recorded in 2 [16.7%]women which was symptomatic and required repeatsurgical treatment

Conclusion: Sacrohysteropexyis effective and safe procedure in women withuterovaginal prolapse who want to preserve theiruteri

Unicornuate uterus with non-communicating horn diagnosis and management

We present a case of unicornuate uterus with a rudimentary horn of non-communicating variety in a young unmarried girl. The case is described because of rarity and difficulties in the diagnosis and management of such congenital malformation

Non Puerperal Uterine Inversion in Unmarried Girl with Submucous Fibroid

A rare case of nonpuerperal uterine inversion caused by a large fundal leiomyoma in an unmarried girl presenting with heavy irregular vaginal bleeding, feeling of mass in vagina, severe dysmenorrhoea and retention of urine. Uterine inversion was diagnosed by clinical examination and radiological investigations. Her inversion was corrected by Haultain procedure performed abdominally

Scar endometriosis: a rare disease occurrence

Endometriosis is a common gynecological condition. It can pose a diagnostic dilemma when presented as endometriosis in the scar. This is a rare disease entity. We discuss a case of abdominal wall endometriosis following caesarian section. It presented as tender nodule in the left region of previous C-section scar, with cyclical pain and swelling. In view of the possibility of scar endometriosis, the mass was completely excised. Pathologic findings were compatible with scar endometriosis