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Dr. Sanchita Karmakar (Resident) Dr. Hemant Deshpande (Prof & HOD of OBGY) Dr. D.Y.Patil Medical College, Pimpri, Pune.
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Postpartum Hemorrhage
Blood loss > 500 ml at vaginal delivery> 1000 ml at Cesarean
ACOG 10% drop in hematocritNeed for blood transfusion
Severe PPH > 1000 ml loss at vaginal delivery
Any amount of blood loss causes S/O Hypovolemic Hemorrhagic Shock - Tachycardia - Hypotension - Reduced urine out
put
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CAUSES OF PPH
FOUR “ T”s
BUT MOST IMPORTANT IS
TONE — MULTIPARA, MANIPULATION,OVER DISTENTION, PROLONGED LABOUR,DRUGS-SEDATION, OXYTOCIN, ABRUPTION,MALFORMATION,INVERSION.
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WHEN MEDICAL MANAGAMENT FAILS
SURGICAL MANAGEMENT
Uterus conserving : NEED OF TIME Definitive - Hysterectomy
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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
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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
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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
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PREREQUISITES G.A CATHETERISATION LOWER UTERINE SEGMANT OPENED DIGITALLY EXPLORE UTERUS ASSESS EFFICACY OF M.B.L STITCH
BIMANUAL COMPRESSIONBIMANUAL COMPRESSION
NO BLEEDINGNO BLEEDING
PT WILL RESPOND TO CBSPT WILL RESPOND TO CBS
CONFIRM EMPTY UTERUSCONFIRM EMPTY UTERUS
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NIL - IF DONE PROPERLY
TOO TIGHT COMPRESSION -- CUT THROUGH STITCH
UTERINE NECROSIS
INTRAPERITONEAL BLEED
COMPLICATIONS
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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
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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%)
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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%)
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Cho’s Multiple Square Suture
Hayman Uterine Compression Suture
Global Stitch By Dr. Gunasheela Bangalore
OTHER COMPRESSION SUTURES
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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.
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TO HELP WHERE THE LIFE BEGINS,WE STAND WITH THE WOMEN,BY SIDE OF THE WOMEN AND BEHIND HER