Place the patient in the lloyd davies position and pass indwelling urinary catheter. Role of modified blynch suture in modern day management. The suture is then threaded through the uterine cavity to emerge at the upper incision margin 3cm above and approximately 4cm from the left lateral border. Moreover, the suture material and needle are the important reasons for our modification of the blynch technique. New dedicated blunt straight needles and sutures for uterine. Media in category b lynch suture this category contains only the following file. The blynch suture figure 1 is placed with the following steps.
In 1997, b lynch et al7 reported a uterine compression suture technique for the. Sep 03, 2016 complications asherman syndrome it may be linked to the square dead space in the uterine cavity where endometrial necrosis may occur haematometra following blynch plus cho suture pyometra occlusion of the cervical lumen is a potential complication when transverse compression sutures are placed uterine wall partial. Christopher b lynch was the first to highlight this revolutionary principle, and other uterine compression suture techniques have since been described by hayman and cho. In the scope of future fertility and pregnancy outcome after blynch suture modifications, we present here the first case of successful uncomplicated term delivery within one year following application of khairys modified blynch suture for management of atonic pph in the preceding pregnancy. Role of modified b lynch suture in modern day management of atonic postpartum haemorrhage vaman b ghodake, suchitra n pandit, shashikant m umbardand abstract aims and objectives. Blynch compression suture as an alternative to paripartum. For the contribution history and old versions of the redirected article, please see its history. A total of 36 women who were managed with the blynch suture, with or without additional surgical procedures following uterine atony unresponsive to medical treatment, were evaluated.
Previous research has reported adoption of b lynch for blood loss of 300 ml, which may be conducted by younger, less experienced obstetricians 6. Closure of the uterine incision by modified continuos mattress suture for better uterine scar integrity. Technique b lynch suture for uterine atony register now, join the community for free access. Globally, uterine atony is the most common cause of postpartum. The increased compression of these sutures will cause the initial. Two additional b lynch sutures are placed lateral to the middle suture. The indications for the b lynch suture should be revisited, and surgical skills should be perfected via simulation training. To evaluate effectiveness of modified b lynch suture in controlling atonic pph. Pdf blynch suture for the treatment of uterine atony. During the placement of suture, patient was placed in frogleg position to assess the compression effect of b lynch suture. Modified blynch suture technique for prevention of. Using a modified blynch technique, an initial suture is placed and secured in the middle third of the uterus.
Role of modified blynch suture in modern day management of atonic postpartum haemorrhage vaman b ghodake, suchitra n pandit, shashikant m umbardand abstract aims and objectives. Mar 11, 2019 postpartum hemorrhage pph is an obstetrical emergency occurring in 46% of live births 1, 2. The aim of this study was to report our clinical experience of applying a uterine flexion suture, which was modified from the b. This is an educational video with animation about performing a b lynch compression suture. Modified blynch suture was used in 40 cases, suffering from atonic pph. To evaluate whether use of the blynch suture is associated with subsequent adverse pregnancy outcomes. Technique blynch suture for hemorragia postparto video. C b lynch et al b lynch brace suture alternative to hysterectomy surgical technique for the control of massive postpartum haemorrhage. Pdf the blynch technique for the management of intraoperative. Women who had postpartum hemorrhage and b lynch suture were compared with those complicated by postpartum hemorrhage but no b lynch suture placement.
In the present study, out of the 24 cases table 1 in which the blynch suture was attempted by skilled operators. It is used to mechanically compress an atonic uterus in the face of. With the surgeon standing on the right and the abdomen opened for caesarian section if applying after vaginal delivery, perform a laparotomy and give a transverse hysterotomy. This is a cohort study of women who experienced postpartum hemorrhage between january 2000 and june 2010 and had a subsequent pregnancy at a single university hospital. The main indication to perform a uterine compression suture is the hemorrhage due to uterine atony, but can be performed in all circumstances in which its.
The uterine compression suture used in our institute was the blynch technique, which has been reported to be effective in the treatment of pph due to uterine atony. The aim of this study was to report our clinical experience of applying a uterine flexion suture, which was modified from the b lynch. We read with great interest the case reported by goojha et al. How to perform a blynch uterine compression suture youtube. Previous research has reported adoption of blynch for blood loss of 300 ml, which may be conducted by younger, less experienced obstetricians 6.
A blynch suture braces and stabilizes the uterus in cases of severe postpartum hemorrhaging. The original b lynch technique and other modified techniques such as hayman and cho7,10,21 need a special long, curved needle for suture through the anterior and posterior wall of the uterus. D demonstrating how to take out one of the stitches. Objectives stepbystep description of the b lynch brace suture and discussion of the current compression suture techniques. Subsequent pregnancy outcome after blynch suture placement. Blynch suture classical modified form was applied in 75 cases. Decrease blood loss following open myomectomy using. The b lynch suture or b lynch procedure is a form of compression suture used in obstetrics.
Approved by the ipqic governing council june 2019 3 task force participants laura green lutheran hospital ft. One advantage of this technique is that it conserves fertility so that the patient can have more children in the future. The utility of the b lynch suture is attributed to its simplicity, safety, ability to preserve life, the uterus and fertility with the benefit of immediate evaluation of hemostatic success 37 of the 60 published case reports in which the b lynch suture was used, only one negative outcome uterine necrosis was documented 38. Role of modified blynch suture in modern day management of. Christopher blynch was the first to highlight this revolutionary principle, and other uterine compression suture techniques have since been described by hayman and cho. To evaluate the success rate and possible complications of the blynch uterine compression sutures in women who suffered from postpartum uterine atony unresponsive to medical treatment. Uterine compression sutures ucss have been used for the management of pph and for avoiding the need for hysterectomy since the introduction of the blynch suture technique in 1997 3,4,5,6. Women who had postpartum hemorrhage and blynch suture were compared with those complicated by postpartum hemorrhage but no blynch suture placement.
To simulate a b lynch compression suture, we use neoprene models. The blynch suture or blynch procedure is a form of compression suture used in obstetrics. Uterine atony during cesarean section was treated by manual compression. Dec 30, 2019 the uterine compression suture used in our institute was the b lynch technique, which has been reported to be effective in the treatment of pph due to uterine atony. This is then fed anteriorly and vertically to enter the posterior wall into the uterine cavity at the same level as the upper anterior entry point. Blynch suture demonstration by prof blynch youtube. The indications for the blynch suture should be revisited, and surgical skills should be perfected via simulation training. Improving health care response to obstetric hemorrhage toolkit. New modified cross b lynch versus classic b lynch in. Lynch surgical technique for the control of massive postpartum. Correct application of the blynch suture distributes tension across the uterine cavity and maintains the uterine tone until involution starts. Jun 09, 2010 we read with great interest the case reported by goojha et al. Satisfactory haemostasis can be assessed immediately after application. Transverse compression suture to control bleeding fro pph placenta previa by prof blynch duration.
Aarp health insurance plans pdf download medicare replacement pdf download medicare benefits pdf download medicare part b pdf download b lynch suture cpt code. Mar 25, 2020 a b lynch suture is a suturing technique to brace and stabilize the uterus in cases of severe postpartum hemorrhage. Complications asherman syndrome it may be linked to the square dead space in the uterine cavity where endometrial necrosis may occur haematometra following blynch plus cho suture pyometra occlusion of the cervical lumen is a potential complication when transverse compression sutures are placed uterine wall partial. Technique blynch suture for uterine atony register now, join the community for free access. Modified blynch alone, succeeded to control atonic pph in 35 87. Permission is granted to copy, distribute andor modify this document under the terms of the gnu free documentation license, version 1. The utility of the blynch suture is attributed to its simplicity, safety, ability to preserve life, the uterus and fertility with the benefit of immediate evaluation of hemostatic success 37 of the 60 published case reports in which the blynch suture was used, only one negative outcome uterine necrosis was documented 38. Uterine compression sutures ucss have been used for the management of pph and for avoiding the need for hysterectomy since the introduction of the.
The original blynch technique and other modified techniques such as hayman and cho7,10,21 need a special long, curved needle for suture through the anterior and posterior wall of the uterus. Whereas blynch suture was promptly adopted throughout the world, we have been attempting to alert physicians to the possible hidden mid or. Media in category blynch suture this category contains only the following file. To evaluate effectiveness of modified blynch suture in controlling atonic pph. The blynch and other uterine compression suture techniques. To evaluate effectiveness of modified blynch suture in controlling atonic postpartum haemorrhage.
The blynch suturing technique brace suture may be particularly useful because of its. The blynch surgical technique for the control of massive. It is used to mechanically compress an atonic uterus in the face of severe postpartum hemorrhage. Sep 08, 20 transverse compression suture to control bleeding fro pph placenta previa by prof b lynch duration. In this sense, the six relatively more intuitive steps of the hayman compression suture figure 1a are easier to remember and to perform in an emergency situation, compared with the ninestep sequence of the blynch suture figure 1b, which may be the reason why the latter had many modifications described.
Endometrial necrosis following blynch suture for uterine atony. The primary outcome was a composite adverse outcome related to placentation abnormalities and included placenta previa, placenta accreta, preeclampsia, preterm birth, or a smallforgestationalage neonate. The increased compression of these sutures will cause the initial suture to loosen. The blynch suture is a form of compression suture used to mechanically compress an atonic uterus in the face of severe postpartum hemorrhage. Pfannenstiel incision or reopen previous caesarean skin incision. A retrospective study of data of all women who delivered between may 2004 and june 2007 was collected from the departments database, to identify patients who had undergone the b lynch procedure. A prospective study conducted at ltmg hospital and ltmm. Conservative surgical management for immediate postpartum. A diagramatic representation of the blynch brace suture the blynch suture or blynch procedure is a form of compression suture used in obstetrics. The blynch suturing technique brace suture may be particularly useful because of its simplicity of. A blynch suture is a suturing technique to brace and stabilize the uterus in cases of severe postpartum hemorrhage. These bites are placed approximately 3 cm from the edge of the hysterotomy incision.
B lynch suture classical modified form was applied in 75 cases. Uterine compression suture technique in the management of. Successful use of the blynch uterine compression suture in. During the placement of suture, patient was placed in frogleg position to assess the compression effect of blynch suture. Removable uterine compression sutures for postpartum haemorrhage. Bimanual compression to test for potential success. Whereas b lynch suture was promptly adopted throughout the world, we have been attempting to alert physicians to the possible hidden mid or. In this surgical case series, we describe a technique where 3 sidebyside b lynch sutures are placed during postpartum hemorrhage at cesarean. Blynch transverse compression suture of the uterus in placenta previa bleeding. Aarp medicarerx plans united healthcare aarp health insurance plans.
Modified blynch suture technique for prevention of postpart. But if any other procedures performed along with this, then you can submit the bill as per the expected level of rvu as per the other procedures involved. This procedure is named for the surgeon who invented it, christopher b. As per archives you need to use 59899 for blynch suture code. The search strategy involved the use of these keywords.
The b lynch suture is a form of compression suture used to mechanically compress an atonic uterus in the face of severe postpartum hemorrhage. Blynch suture for the treatment of uterine atony article pdf available in singapore medical journal 507. Correct application of the b lynch suture distributes tension across the uterine cavity and maintains the uterine tone until involution starts. Successful term delivery after khairys modified blynch. As per archives you need to use 59899 for b lynch suture code. In this surgical case series, we describe a technique where 3 sidebyside blynch sutures are placed during postpartum hemorrhage at cesarean. Two additional blynch sutures are placed lateral to the middle suture. Decrease blood loss following open myomectomy using modified. Objectives stepbystep description of the blynch brace suture and discussion of the current compression suture techniques. The full video of surgical management of postpartum haemorrhage is available.
To evaluate whether use of the b lynch suture is associated with subsequent adverse pregnancy outcomes. C blynch et al blynch brace suture alternative to hysterectomy surgical technique for the control of massive postpartum haemorrhage. Please blynch suturespat posted mon 21st of february. Flowchart of initial resuscitation and surgical response to primary postpartum haemorrhage \pph\ keywords postpartum haemorrhage, hemorrhage, pph, obstetric haemorrhage, uterine atonia, oxytocics, uterotonics, tranexamic acid, blynch suture, uterine artery embolism, bilateral ligation, queensland clinical guidelines, queensland health. The discussion was closed on 30 september 2012 with a consensus to merge. A blynch suture may cause fertility problems, even though the procedure is intended to preserve fertility. Intubation pressers central line arterial line admission to icu admission to higher acuity unit transfer to. Pdf this paper reports the experience of 150 blynch suture applications for the management of uterine atony during caesarean section that did not. Aug 24, 2018 moreover, the suture material and needle are the important reasons for our modification of the b lynch technique.