Shakila Yasmin.
"B-lynch" brace suture as an alternative to Hysterectomy for severe PPH.
Pak J Med Res Jan ;42(3):146-8.

A 20 years old primigravida was admitted at gestational age of 41 weeks for induction of labour. Physical examination revealed a lady of average build and pink look. Her respiratory and cardiovascular systems were unremarkable. On abdominal examination fetus was longitudinal, cephalic 5/5th palpable. Bishop score was poor and pelvis was adequate clinically. On ultrasonography, placental maturity was grade III and liqour was just adequate, BPD 92 and FL 73. After doing CTG record for 10 minutes, prostin E2 was placed in the posterior vaginal fornix. Partogram was maintained, artificial rupture of membranes done after 4 hours when she was 5cm dilated, fully effaced and vertex reached at -2 station. Outlet forceps delivery with episiotany was done, due to type II decelerations. Third stage managed actively. Immediately after the stitching of episiotomy, patient got heavy bleeding per vaginum: uterine massage and bimanual compression were performed along with intravenous oxytocics. Blood transfusion was started and patient shifted to operation theatre due to failure of conservative measures to arrest PPH. Examination under anesthesia done and cervical, vaginal, or perineal lacerations were ruled out. Meanwhile, PGF2µ was also given. Since the patient was still bleeding profusely so laparotomy performed. Bilateral uterine and internal iliac arteries ligation resulted in no benefit. Uterus was getting atonic again and again between the acts of compression and massage. So, the B-Lynch Suture was applied as a "Last Ditch" measure before hysterectomy which proved to be successful. Patient remained well and was discharge on 6th post operative day.

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