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Background: Primary postpartum hemorrhage (PPH) due to atonicity during lower segment cesarean section is commonly seen in obstetric practice. Usually, it responds to uterotonics but at times it may lead to life-threatening complications. B-Lynch brace suture is a fertility-preserving alternative surgical technique used in patients with primary atonic PPH not responding to uterotonics. This study was conducted to find out the efficacy of B-Lynch sutures in the surgical management of atonic PPH and prevention of obstetric hysterectomy in the same patients. Materials and Methods: The study included 34 patients with primary atonic PPH during cesarean section refractory to oxytocics and managed with B-Lynch brace sutures. It was a cross-sectional observational study conducted over 1 year at a tertiary hospital. The amount of blood loss, any additional surgical procedure required, and associated complications were studied in these patients. Results: Fertility could be preserved in 100% of the patients undergoing B-Lynch sutures for primary atonic PPH, following the failure of the medical line of management. No major complications including uterine wall necrosis or pyometra were observed in any of these patients. Conclusion: B-Lynch suture is a safe, effective, simple, life-saving, and fertility-preserving surgical technique in the treatment of primary PPH that requires lesser expertise. So it can easily be used before major interventions such as uterine devascularization or obstetric hysterectomy.
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INTRODUCCIÓN Y OBJETIVOS: La Hemorragia Postparto (HPP) es uno de los grandes desafíos para el equipo multidisciplinario y sigue siendo una de las principales causas de muerte materna en el mundo, pese a los adelantos en su manejo. Se define como la hemorragia que produce compromise hemodinámico de la paciente e involucra entre el 1 al 5% de todos los partos. Dentro de las técnicas quirúrgicas conservadoras, existen las suturas compresivas, tales como la sutura de B-Lynch. Nuestro objetivo es determinar la efectividad de la sutura de B-Lynch como manejo quirúrgico conservador de hemorragia postparto por inercia uterina, a través de la necesidad de reintervención o de recurrir a la histerectomía obstétrica como manejo quirúrgico final. MÉTODOS: Estudio retrospectivo observacional, a través de revisión de fichas clínicas de pacientes sometidas a técnica B-Lynch entre enero de 2013 y diciembre de 2016, en el Servicio de Ginecología y Obstetricia del Hospital Dr. Luis Tisné Brousse. RESULTADOS: En 48 pacientes, la efectividad de la sutura de B-Lynch como técnica única o asociada a ligadura arterias uterinas o hipogástricas fue de 91,7%. Requirieron reintervención 8,3%, no se reportaron muertes fetales ni maternas y se obtuvo sólo un recién nacido con Apgar inferior a 7 a los 5 minutos. CONCLUSIONES: La sutura de B-Lynch es una técnica segura, de rápido acceso y con Buenos resultados, por lo que recomendamos su uso en la HPP por inercia uterina que no responde a manejo médico y con deseos de preservación uterina.
INTRODUCTION AND OBJECTIVES: Postpartum haemorrhage (HPP) is one of the major challenges for the multidisciplinary team and remains one of the leading causes of maternal death in the world despite advances in its management. It is defined as hemorrhage that produces hemodynamic compromise of the patient and involves between 1 and 5% of all deliveries. Within conservative surgical techniques, there are compressive sutures, such as the B-Lynch suture. Our goal is to determine the effectiveness of B-Lynch suture as a conservative surgical management of postpartum hemorrhage by uterine inertia, through the need for reoperation or to resort to obstetric hysterectomy as final surgical management. METHODS: Retrospective observational study, through review of clinical files of patients submitted to B-Lynch technique between January 2013 and December 2016, at the Gynecology and Obstetrics Service of the Dr. Luis Tisné Brousse Hospital. RESULTS: In 48 patients, the effectiveness of the B-Lynch suture as a single technique or associated with ligature uterine or hypogastric arteries was 91.7%. 8.3% were reoperated, fetal or maternal deaths were not reported, and only one Apgar score was less than 7 at 5 minutes. CONCLUSIONS: The B-Lynch suture is a safe technique, of fast access and good results, so we recommend its use in PPH by uterine inertia that does not respond to medical management and with desires of uterine preservation.
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Humanos , Feminino , Adolescente , Adulto , Adulto Jovem , Inércia Uterina/fisiopatologia , Técnicas de Sutura , Hemorragia Pós-Parto/cirurgia , Inércia Uterina/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Hemorragia Pós-Parto/etiologiaRESUMO
Objective To investigate the appropriate timing of B-lynch suture in the treatment of atonic postpartum hemorrhage during cesarean section.Methods A total of 90 patients with atonic postpartum hemorrhage during cesarean section from January 2012 to December 2014 in our hospital were included in the study.They were divided into two groups, early suture group (applying B-lynch suture when the amount of postpartum hemorrhage reaching 500 ml, n=66 cases) and late suture group (applying B-lynch suture when the amount of postpartum hemorrhage reaching 1000 ml, n=24 cases).The hemostatic effect, amount of bleeding, blood transfusion rate, incidence of DIC, duration of hospitalization, and the puerperal morbidity were compared between the two groups.Results All the 90 patients were successfully treated and were discharged after comprehensive treatment.The amount of postpartum hemorrhage of the early suture group was (656±118) ml, which was significantly less than that of the late suture group [(1550±432) ml, t=-10.003, P=0.001].The rate of blood transfusion of the early suture group was 3.0% (2/66), which was significantly lower than that of the late suture group [(50.0%, 12/24), x2=26.092, P=0.000].There was no case of DIC in the early suture group, and the incidence of DIC in the late suture group was 16.7% (4/24), with the difference statistically significant (Fisher''s exact test, P=0.004).The puerperal morbidity in the early suture group was 3.0% (2/66) and that of the late suture group was 25.0% (6/24), with statistically significant difference (x2=7.952, P=0.005).There was no statistically significant difference in the hospitalization stay between the two groups (P>0.05).Conclusions B-Lynch suture is an effective method in the treatment of atonic postpartum hemorrhage during cesarean section, and early use of it can get better curative effect, such as less bleeding amount and lower rates of blood transfusion, DIC and complications like puerperal morbidity.In case the bleeding volume reaches 500 ml and the general conservative hemostatic methods are ineffective, B-Lynch suture is recommended immediately.
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Objective To investigate the efficacies of intrauterine balloon tamponade, intrauterine gauze tamponade and B-Lynch suture in prevention and treatment of postpartum hemorrhage. Methods A total of 266 patients with high risk of postpartum hemorrhage or postpartum hemorrhage in our hospital from January 2013 to October 2014 were included in this study. They received intrauterine Bakri balloon tamponade (n=114), intrauterine gauze tamponade (n=69) or B-Lynch suture (n=83). The hemostatic effects of three methods and their relationship with different hemostasis occasions and high risk factors were analyzed. Results The hemostatic rates of intrauterine balloon tamponade, gauze tamponade and B-Lynch suture were 90.4%, 94.2% and 92.8%, respectively, with no significant differences found between the 3 groups (P>0.05). The hospitalization time, postpartum infection or involution of the uterus of three methods were not significantly different (P>0.05). The operation period was (46.08±13.8) min for intrauterine Bakri balloon tamponade, (56.49±12.94) min for intrauterine gauze tamponade, and (52.36±21.11) min for B-Lynch suture,with that of Bakri balloon group being significantly shorter than the other two groups (P<0.01). As for hemostatic occasion, 134 cases received preventive hemostatic treatment and were all successful, while 132 cases receiving hemostatic treatment had a successful rate of 84.1%, being significantly lower than that of the prevention hemostasis group (P<0.01); moreover, the postpartum infection rate was significantly lower in the prevention group compared with hemostatic treatment group (P<0.01). When placenta factor and uterine factor exist at the same time, the bleeding rate and bleeding volume of the mixed factor were significantly higher than that of single factor (P<0.01). Conclusion The three hemostasis methods have no differences in their hemostatic effects, hospitalization time, postpartum infection and uterine involution, with Bakri balloon's operation having the shortest time, therefore it may serve as an emergency hemostasis method to win more time for further treatment. The success rate of hemostasis depends not on the hemostasis method, but on the right occasions, the earlier the better. When placenta factor and uterine factor exist at the same time, the failure rate of hemostasis is higher, and emergency plans should be taken to reduce postpartum hemorrhage as soon as possible.
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Objective To investigate clinical efficacy and safety of carboprost tromethamine injection combined with low B -Lynch suture for intractable postpartum hemorrhage placenta previa.Methods 125 cases of intractable postpartum hemorrhage placenta previa were divided into two groups according to treatment(n =62)with the observation group(n =63),the control group was administered oxytocin,and the line in the placental separation surface 8 interrupted suture;the observation group was used carboprost tromethamine injection combined with low B -Lynch suture.Clinical efficacy,blood loss,bleeding,postoperative bleeding 2h,24h after blood loss,transfusion rate and index sex hormone levels were compared before and after treatment.Results (1)After treatment,total effec-tive rate of the control group and observation group was 77.42%(48 /62)and 95.24%(60 /63)respectively.There was a statistically significant difference between the two groups(P 0.05),and after treatment,the index level differences were not statistically significant(P >0.05);(4)the two groups during treatment,liver and kidney functions were normal,three cases of the control group and two cases of the observation group occured nausea and vomiting.Conclusion Carboprost tromethamine injection combined with low B -Lynch suture has significant effect, a small amount of bleeding,high security for intractable postpartum hemorrhage placenta previa,which should be promoted.
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Objective To observe the clinical effect of modified B-lynch suture in the treatment of patients with pernicious placenta pre-via.Methods A total of 46 patients with pernicious placenta previa in our hospital were randomly divided into the modified B-lynch suture treatment group(modified group)and the conventional therapy group(convention group),with 23 cases in each group.The operation time, menstrual recovery time and lochia sanguinea time,postpartum hemorrhage,intraoperative blood soss,abnormal temperature time,placenta ac-creta,hysterectomy and neonatal asphyxia between the two groups were compared.Results The intraoperative blood soss and postpartum hemorrhage of modified group was less than those of convention group,the menstrual recovery time was shorter than that of convention group and the rate of resection of uterine was lower than that of conventional group,with significant difference (P 0.05).Conclusion The clinical effect of modified B-lynch suture in the treatment of dangerous placenta previa is significant.
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Objective To study the curative effects for modified B-Lynch suture and uterine packing for the treatment of uterine atony postpartum hemorrhage.Methods 82 patients with uterine atony postpartum hemorrhage were randomly divided into the two groups,the observation group(n=41) and the control group(n=41).The patients in the observation group were operated through modified B-Lynch suture,while the patients in the control group were operated through uterine packing.For both groups,operative time,blood loss,blood transfusion,whether hysterectomy, puerperal morbidity,three diameter of the uterus were compared.Results Postoperative lochia without exception,no serious complications and adverse reactions occurred incision Ⅱ/A healed.The total effective rate was 100.0%. There were three cases of the control group after surgery which were ineffective hysterectomy surgery to stop bleeding, the total effective rate was 92.7%.There were significant differences between the two groups (χ2 =4.720, P 0.05).Conclusion Treatment effect through modified B-Lynch suture for cesarean section uterine atony postpartum hemorrhage was significantly better than the uterine packing method.
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Objective To investigate the clinical efficacy of B-Lynch suture in the treatment of massive hemorrhage during cesarean section. Methods Thirty-six patients with massive hemorrhage during cesarean section were applied with B-Lynch suture when bleeding was not controlled through conventional treatment. Results The bleeding of 36 cases were all controlled effectively when treated with B-Lynch suture,no one was operated again because of poor blood circulation or rebleeding, avoided hysterectomy, no postoperative complications occurred, there was no abnormal of uterine involution and the menstrual time.Conclusions The operation of B-Lynch suture is easy, hemostasis rapidly,reliable,persistently,and with high success rate. It can reserve the uterus maximumly, reserve the fertility function of the patient. It is the effective surgical hemostasis in the treatment of massive hemorrhage during cesarean section, and without special equipment, suitable for primary hospital use when emergency,worthing promotion.
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Antecedentes: La hemorragia postparto (HPP) continúa siendo una de las patologías más prevalentes en la morbimortalidad materna en todo el mundo, especialmente en los países subdesarrollados. Distintos protocolos de manejo y técnicas se han desarrollado en los últimos años para su control. La sutura de B-Lynch surge como una herramienta útil y reproducible. Objetivo: Demostrar los beneficios de la técnica para el control de la HPP. Método: Serie de 5 casos en los que se realizó la sutura de B-Lynch en el Servicio de Obstetricia y Ginecología del Hospital Carlos Van Buren. Se identifican 5 casos en los que se realizó la técnica. Resultados: En los 5 casos se logró exitosamente controlar la HPP y preservar el útero. Una de las pacientes logró un embarazo posterior exitoso. Conclusión: Nuestros resultados permiten afirmar que la técnica de B-Lynch es segura, útil y reproducible en el manejo de la HPP.
Background: The postpartum haemorrhage (PPH) continues to be a prevalent problem affecting maternal morbimortality all over the world, particularly in non-developed countries. Different protocols of management and new techniques have been developed through these last years to control and treat PPH. The B-Lynch suture appears to be a useful and reproductible tool. Objectives: To show the benefits of the technique in the management of PPH. Method: A retrospective review of five cases in which B-Lynch suture was made, with the postoperatory controls and histeroscopics evaluations. Results: In all cases, successfully PPH was controlled and the uterus preserved. In one patient a successfully pregnancy and delivery was achieved. Conclusion: The B-Lynch suture is secure, useful and reproducible technique in the management of PPH.
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Humanos , Feminino , Gravidez , Adulto , Hemorragia Pós-Parto/cirurgia , Procedimentos Cirúrgicos Obstétricos/métodos , Técnicas de Sutura , Hemorragia Pós-Parto/etiologia , Hemostasia Cirúrgica/métodos , Inércia Uterina/cirurgia , Inércia Uterina/patologia , Reprodutibilidade dos TestesRESUMO
Objective To investigate the application opportunity and effect of B-Lynch suture in severe postpartum hemorrhage during cesarean section. Methods One hundred patients with high risk to postpartum hemorrhage were randomly divided into two groups. Group A was given with preventive treatment by B-Lynch suture after the placenta was born. Group B was given with traditional treatment, such as kneading the uterus, pressing, "8" suture, stuffing with gauze first. B-Lynch suture was used after the failure of traditional treatment or the amount of bleeding was over 400 ml.At the same time, another 50 patients without severe postpartum hemorrhage were selected as control (group C). Observed the difference of the amount of bleeding during different time, the operation time and comphcations among the three groups. Results The amount of bleeding during operation and 2 h after childbirth in group A [(266.00±29.90),(301.33±40.30) ml] were obviously less than those in group B[(512.67±202.12), (554.17±201.78)ml](P<0.01). The operation time in group A [(33.73±2.28)min] was shorter than that in group B [(49.33±10.40) min] (P<0.01). The incidence rate of severe postpartum hemorrhage in group A (6%, 3/50) was lower than that in group B (64%, 32/50) (P<0.01). Every parameter in group A was similar with group C. There were no serious complications during and after operation. Conclusions The preventive use of B-Lynch suture in patients with high risk to postpartum hemorrhage attains much better effects, and depresses the incidence rate of severe postpartum hemorrhage, and also improves the living quality. B-Lynch suture should be. used widely in patients with high risk to postpartum hemorrhage preventively.
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Objective To investigate the effect of modified B-Lynch suture in treatment of hemorrhage during cesarean section and its nursing. Methods Retrospective analysis was carded in the curative effect of the modified B-Lynch suture among 22 patients who suffered from postpartum hemorrhage during cesarean section. Results Postpartum hemorrhage among 22 patients was under well control and their uteruses were reserved successfully. Conclusions The modified B-Lynch suture is an effective intervention when used to treat intra- operative bleeding during cesarean section and when combined with appropriate nursing care, the patients would make an early recovery.
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[Objective]To explore effective method for postpartum hemorrhage caused by uterine intertia.[Methods]We performed improved B-Lynch suture on such 13 patients.[Results]13 cases were effectively controlled with good prognosis.[Conclusion]The said method has marked cure effect.