Management of massive postpartum hemorrhage by B-lynch brace suture

ABSTRACT

A 28 years old, 4th grade with three alive females delivered by lower segment cesarean section, was admitted at 29 weeks gestation with the complaint of mild off and on bleeding per vaginum for five weeks. She was a diagnosed case of major degree of anterior placenta praevia with intrauterine growth restriction. She was managed conservatively during her antenatal stay for 22 days in the hospital. One unit of blood was transfused. She had an emergency cesarean section at 32 weeks for sudden onset of heavy vaginal bleeding [more than 500 ml in two hours]. An alive female baby weighing 1.2 kg was delivered. Lower segment was highly vascular and bled more than 1000 ml during the operation despite ecbolics, haemostatic sutures to the placental bed in the lower uterine segment and pressure pack. B-Lynch suture was applied successfully. One unit of blood was transfused peroperatively. Patient remained well and was discharged on 5th postoperative day. She reported significant lower abdominal cramps on first two days after operation