Transcript Medical Management of PPH

MODIFICATION OF CHRISTOPHER BALOGUN –
LYNCH STITCH IN PREVENTING POST PARTUM
HEMORRHAGE
Dr. Sanchita Karmakar (Resident)
Dr. Hemant Deshpande (Prof & HOD of OBGY)
Dr. D.Y.Patil Medical College, Pimpri, Pune.
Postpartum Hemorrhage
Blood loss
ACOG
Severe PPH
> 500 ml at vaginal delivery
> 1000 ml at Cesarean
10% drop in hematocrit
Need for blood transfusion
> 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
CONFIRM EMPTY UTERUS
 ASSESS EFFICACY OF M.B.L STITCH
BIMANUAL COMPRESSION
NO BLEEDING
PT WILL RESPOND TO CBS
COMPLICATIONS
NIL
- IF DONE PROPERLY
TOO TIGHT COMPRESSION -CUT THROUGH STITCH
UTERINE NECROSIS
INTRAPERITONEAL BLEED
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%)
OTHER COMPRESSION SUTURES
 Hayman Uterine
Compression Suture
Cho’s Multiple Square Suture
Global Stitch By
Dr. Gunasheela Bangalore
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