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Postpartum hemorrhage (PPH) and the B-Lynch technique


Dr Faustino R. Pérez-López
Chairman of Obstetrics and Gynecology
Spain
_________________

Postpartum hemorrhage-related Links

Obstetrical hemorrhage comprises: 1) bleeding after 24 weeks of pregnancy and before delivery (antepartum hemorrhage) generally related to placenta previa, placental abruption, trauma and uterine rupture, and 2) postpartum hemorrhage (PPH) related to is associated to uterine atony, retained products of conception, genital trauma, coagulation defects, inverted uterus, and secondary hemorrhages (i.e pre-eclampsia, intrauterine sepsis, retained dead fetus, primary coagulopathy, etc).

Uterine atony after delivery accounts for 75-90% of all PPHs. This rate may vary depending on the studied region of the world. Severe PPH hemorrhages are frequently associated with disseminated intravascular coagulopathy (DIC) and high mortality risk. Various approaches have been proposed for the management of PPH due to atony yet a significant number of cases end in hysterectomy, procedure not exempt of risks and or complications. Women who survive a PPH are bound to have severe anemia and infections and are more prone to die in the year following PPH episode.

The International Federation of Gynecology and Obstetrics (FIGO) and other international organizations have given different recommendations to prevent and treat PPH. A very successful session during the South African FIGO congress was that devoted to the management of PPH. The B-Lynch technique comprises a compressive suture of the uterine fundus placed after hysterotomy and fetal extraction [B-Lynch et al 1997, Ferguson et al 2000, Hayman et al 2002]. The brace suture is easy to be applied and provides the possibility of preserving female fertility. Moreover the procedure is easier to perform than hysterectomy or a hypogastric artery ligature, most convenient for developing countries with low resources and high obstetrical output.

Post partum hemorrhage. Summary (1min, 39 sec).

Pathfinder International: Prevention and Management of Postpartum Hemorrhage. This clinical training video provides detailed guidance on the active management of the third stage of labor.

How to do the B-Lynch suture (GHS), 2.36 min.

B-Lych suture, 1,51 min.

Bakri Postpartum Balloon: Procedural steps and animation.

Bibliography

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Last update: 13 May 2011

 

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