Prophylactic B-Lynch Suture During Emergency Caesarean Section In Women At High Risk Of Uterine Atony: A Pilot Study

摘要

A pilot study to evaluate effect of elective B-Lynch suture in preventing atonic PPH was carried out on seven women undergoing emergency (Em) caesarean section (LSCS) with additional risk factors for atony of uterus. Five women were selected before start of LSCS with risk factors like general anaesthesia, chorio-amnionitis, preeclampsia, prolonged labour, second stage arrest, multiple gestation and use of magnesium sulphate. Two women were selected during the caesarean section when uterus remained atonic despite post delivery Oxytocic. Before the closure of uterus B-Lynch suture was applied. Need for additional intervention or use of blood transfusion (BT) was evaluated. None of the women required BT or additional pharmacological or surgical intervention. No intra operative or postoperative or six months follow up complication were noted. In conclusion elective B-Lynch suture is cheap, quick and appeared to be effective in preventing atonic PPH in women undergoing Em LSCS who are at high risk for haemorrhage. Introduction PPH represents a serious obstetric emergency and is a cause of significant maternal mortality and morbidity ranging from minor ailment like fatigue, tiredness, failure to breast feed, need for haematinics to major ailments like blood transfusion , admission to intensive care unit, renal failure, liver failure, adult respiratory distress syndrome and loss of fertility. Many articles have been written and protocols have been made and practised on the management of PPH in obstetric units in the developed countries. Recently focus is concentrated on prevention of PPH. Active management of the third stage by intramuscular or intravenous injection of oxytocic is practiced for a long time. Other prophylactic measures are on trial. Misoprostol a cheap and stable drug has emerged as an alternative drug for management of third stage of labour 1 . Surgical prophylaxis in the form of balloon occlusion or arterial catheterization with or without embolisation to reduce intraoperative blood loss is being tried in cases of placenta previa especially in patients with a previous uterine scar 2 . Need for prophylactic Oxytocic infusion after delivery in presence of risk factors is considered 3 . Elective B-Lynch suture is described during caesarean section in parturient with congenital heart disease, to avoid the need for Oxytocic and to prevent atony of uterus 4 . In this article I have described prophylactic B-Lynch suture in women undergoing emergency caesarean section who have additional high risk factors for atony of uterus.