Dr. Sanchita Karmakar (Resident) Dr. Hemant Deshpande (Prof & HOD of OBGY) Dr. D.Y.Patil Medical College, Pimpri, Pune.

Postpartum Hemorrhage

Blood loss > 500 ml at vaginal delivery> 1000 ml at Cesarean

ACOG 10% drop in hematocritNeed for blood transfusion

Severe PPH > 1000 ml loss at vaginal delivery

Any amount of blood loss causes S/O Hypovolemic Hemorrhagic Shock - Tachycardia - Hypotension - Reduced urine out

put

CAUSES OF PPH

FOUR “ T”s

BUT MOST IMPORTANT IS

TONE — MULTIPARA, MANIPULATION,OVER DISTENTION, PROLONGED LABOUR,DRUGS-SEDATION, OXYTOCIN, ABRUPTION,MALFORMATION,INVERSION.

WHEN MEDICAL MANAGAMENT FAILS

SURGICAL MANAGEMENT

Uterus conserving : NEED OF TIME Definitive - Hysterectomy

CHRISTOPHER BALOGUN-LYNCH

•In 1997 he published a description of the B-Lynch Brace suture for post partum hemorrhage

•His Excellency of the President conferred the honor of “Grand Officer Of the Republic of Sierra Leone” in recognition of profound contribution in the area of obstetrics

B-Lynch Procedure

Aims & Objectives:To evaluate effectiveness of modified B-Lynch suture in controlling atonic PPH.

Material & method: This is a study of 18 cases of PPH managed by Modified B – Lynch Stitch by Dr. Hemant Deshpande from 1st January 2001 to 31st December 2009 at Dr. D.Y.Patil Medical college

MOD. CHRISTOPHER B LYNCH STITCH - BY DR. HEMANT DESHPANDE

Symmetrical Anchoring stitches at 3 places on uterus Ant wall – Fundus ---- Post wall

CAT GUT 1 OR 2 NO NO SLIPAGE OF STITCH MODEST SYMMETRICAL COMPRESSION NO UNEVEN COMPRESSION NO RISK OF GANGRENE OF UTERUS MECHANICAL STIMULATION

PREREQUISITES G.A CATHETERISATION LOWER UTERINE SEGMANT OPENED DIGITALLY EXPLORE UTERUS ASSESS EFFICACY OF M.B.L STITCH

BIMANUAL COMPRESSIONBIMANUAL COMPRESSION

NO BLEEDINGNO BLEEDING

PT WILL RESPOND TO CBSPT WILL RESPOND TO CBS

CONFIRM EMPTY UTERUSCONFIRM EMPTY UTERUS

NIL - IF DONE PROPERLY

TOO TIGHT COMPRESSION -- CUT THROUGH STITCH

UTERINE NECROSIS

INTRAPERITONEAL BLEED

COMPLICATIONS

OUR EXPERIENCE 18 CASES OF ATONIC PPH MANAGED BY

MOD. CHRISTOPHER B LYNCH STITCH IN LAST 10 YRS

3 LSCS & 15 FTND ATONIC PPH MAINLY DUE TO

MULTIPARITY & PROLONGED LABOUR

RESULTS

16 CASES (89%) RESPONDED WELL WITHOUT ANY COMPLICATIONS

BLOOD TRANSFUSION WAS GIVEN IN 16 PATIENTS (89%)

2 REQUIRED INTERNAL ILLIAC ARTERY LIGATION (11%)

TUBAL LIGATION IN 9 CASES(50%)

RESULTS ON FOLLOW UP FOLLOW UP USG AFTER 6 WKS

SHOWING NORMAL UTERINE CONTOUR & ANATOMY IN ALL CASES

ON LONG TERM FOLLOW UP – - NO MENSTRUAL IRREGULARITY - 7 PTS CONCIEVED AGAIN & DELIVERED

WITHOUT ANY COMPLICATIONS(78%)

Cho’s Multiple Square Suture

Hayman Uterine Compression Suture

Global Stitch By Dr. Gunasheela Bangalore

OTHER COMPRESSION SUTURES

CONCLUSION

Modified B-Lynch technique is an effective uterus conserving procedure with a relatively low morbidity to control severe PPH without hampering future fertility.

Uterine compression sutures if done correctly and timely ,have replaced uterine artery ligation, hypogastric artery ligation & postpartum hysterectomy to a greater extent for the surgical treatment of uterine atony.

TO HELP WHERE THE LIFE BEGINS,WE STAND WITH THE WOMEN,BY SIDE OF THE WOMEN AND BEHIND HER