B-Lynch Sutures for Postpartum Hemorrhage
The B-Lynch brace suture is a uterine compression technique indicated for severe postpartum hemorrhage due to uterine atony that fails to respond to uterotonic medications, and should be performed before considering hysterectomy to preserve fertility. 1
Indications
The B-Lynch suture is specifically indicated for:
- Primary indication: Massive postpartum hemorrhage from uterine atony (75-90% of primary PPH cases) that has failed conservative management with uterine massage and uterotonics (oxytocin, syntometrine, prostaglandins) 1
- Timing: Should be applied at cesarean section or after laparotomy when medical management fails, but before proceeding to more radical interventions like hysterectomy 2
- Success rate: Controls bleeding in approximately 77-85% of cases when atony is the primary cause 3, 4
Technique Overview
The B-Lynch brace suture is a compression suture running through the full thickness of both anterior and posterior uterine walls 2. The key advantages include:
- Simplicity of application requiring only basic surgical skills (unlike complex devascularization procedures or internal iliac artery ligation) 1
- Ability to assess hemostasis both before and immediately after suture application 1
- Can be combined with vessel ligation if needed (used alone in 55% of cases, combined in 45%) 3
The technique creates a vertical compression effect that mechanically controls bleeding by compressing the uterine vasculature.
Suture Selection
Use a slowly absorbable monofilament suture for the B-Lynch technique. While the obstetric literature doesn't specify exact suture material as rigidly as abdominal wall closure guidelines, the principles from emergency laparotomy closure are applicable 5:
- Absorbable vs non-absorbable: Slowly absorbable sutures are preferred as they may decrease pain while maintaining adequate tensile strength 5
- Monofilament preferred: Lower infection risk compared to multifilament 5
- Commonly reported materials include chromic catgut or synthetic absorbable sutures (PDS, Vicryl)
Clinical Outcomes and Follow-up
- Hysterectomy avoidance: 77-80% success rate in preserving the uterus 3, 6
- Postoperative course: Generally uneventful in 93% of cases 6
- Menstrual function: Normal menses resume with no reported differences from pre-pregnancy patterns 6
- Fertility preservation: Subsequent pregnancies have been reported with normal conception 6
- Uterine cavity: Hysteroscopy shows normal findings in successfully treated cases 6
Critical Pitfalls
Rare but serious complication: Pyometra in an ischemic uterus requiring delayed hysterectomy has been reported (1/15 cases in one series) 6. Monitor for signs of infection and uterine necrosis postoperatively.
When to proceed to hysterectomy: If the B-Lynch suture fails to control hemorrhage after application, do not delay proceeding to hysterectomy or other definitive interventions 1.
The B-Lynch technique represents a paradigm shift from immediate hysterectomy to fertility-preserving surgery, with over a decade of evidence supporting its safety and efficacy 4.