The B-Lynch suture technique for postpartum haemorrhage: a decade of experience and outcome.

SUMMARY: Historically, postpartum haemorrhage (PPH) has resulted in mortality and morbidity. Of the three well known messengers of death in obstetric practice, severe postpartum haemorrhage is the most menacing for the midwife and obstetrician. Mumtaz Mahal (1630--Wife of Emperor Shah Jahan) and Princess Charlotte Augusta of Wales (1817) both died from massive PPH. William Smellie, one of the greatest obstetricians, wrote his famous treaty on death resulting from uncontrollable massive postpartum haemorrhage. Improvements over the last 100 years include the introduction of ergometrine and prostaglandin and the invention of the B-Lynch suture and its modifications to improve the conservative management of this life-threatening condition. The B-Lynch surgical technique was first invented in 1997 and it is now timely to review a decade of experience and publications. The rising caesarean section rate and the emergency nature of most PPH remain a constant reminder for the need of effective intervention. A robust protocol is essential (one is being produced by this team) to manage this problem with consensus between obstetricians, anaesthetists, midwives, interventional radiologist and haematologist for prompt and coordinative care in such a life-threatening situation. Modifications of B-Lynch technique were introduced later (Cho et al. 2000; Hayman et al. 2002) and need careful evaluation.