Uterine necrosis following B Lynch suture: a rare complication
Keywords:Asherman’s syndrome, B Lynch suture
The B-Lynch uterine suture brace is a relatively new technique used for treatment of postpartum haemorrhage. These uterine compression sutures have achieved hemostasis while preserving fertility in many women and thus their efficacy and safety have been time tested. Very few complications have been reported following B Lynch suture. These include Asherman’s syndrome, hematometra, pyometra, localized areas of uterine necrosis and full-thickness defects in the lower uterine segment or uterine fundus and erosion of uterine wall. Herewith, reporting a case of 23-year-old woman who underwent cesarean section for breech presentation. She had atonic PPH for which uterine artery ligation was done along with B-lynch suture. She developed uterine necrosis for which hysterectomy was done. Microsections showed that endometrial cavity was filled with gangrenous slough extending to variable extent in myometrium and cervix.
Kwast BE. Postpartum hemorrhage: its contribution to maternal mortality. Midwifery. 1991;7:64-70.
World Health Organisation. Maternal mortality: a Global Factbook. Geneva, WHO; 1991. Available at http://apps.who.int/iris/bitstream/10665/38317/1/WHO_MCH_MSM_91.3.pdf
Khan KS, Wojclyle D, Say L, Gulmazoglu AM, Vanlook PF. WHO analysis of causes of maternal death, a systematic review. Lancet. 2006;267:1066-74.
B-lynch C, Coker A, Lawal AH. The B-lynch surgical technique for the control of massive postpartum hemorrhage: an alternative to hysterectomy? Five cases reported. Br J Obstet Gynecol. 1997;104:372-5.
Pahlavan P, Nezhat C. Haemorrhage in obstetrics and gynecology. Curr Opin Obstet Gynecol. 2001;13(4);419-424.
Evan S, MeShane P. The efficacy of internal iliac artery ligation in obstetric haemorrhage. Surg Gynecol Obstet. 1985;160;250-3.
Roman AS, Rebarber A. Seven ways to control post-partum haemorrhage. Contemp Obstet Gynecol. 2003;98(3):34-53.
Wu HH, Yeh GP. Uterine cavity synechiae after hemostatic square suturing technique. Obstet Gynecol. 2005;105:116-7.
Treloar EJ, Anderson RS, Andrews HS, Bailey JL. Uterine necrosis following B-Lynch suture for primary postpartum haemorrhage. Br J Obstet Gynecol. 2006;113:486-8.
Ochoa M, Allaire AD, Stitely ML. Pyometria after hemostatic square suture technique. Obstet Gynecol 2002;99:506-9.
Akoury H, Sherman C. Uterine wall partial thickness necrosis following combined B-Lynch and Cho square sutures for the treatment of primary postpartum hemorrhage. J Obstet Gynaecol Can. 2008;30:421-4.