Efficacy of Bilateral Uterine Artery Ligation versus B-lynch Suture in Primary Postpartum Haemorrhage due to Uterine Atony in Lower Segment Caesarean Section: An Interventional Study

Abstract

Introduction: Postpartum Haemorrhage (PPH) is the leading cause of maternal mortality in both developing and developed countries. PPH is a severe obstetric emergency that often occurs unexpectedly, leaving birth attendants unprepared to handle it on a regular basis. Aim: To evaluate the efficacy and complications of the Bilateral Uterine Artery Ligation (BUAL) technique and B-lynch sutures in Lower Segment Caesarean Section (LSCS) for primary PPH caused by uterine atony. Materials and Methods: A hospital-based prospective, interventional study was conducted at a secondary care centre in the inpatient Department of Obstetrics and Gynaecology at District Hospital, Tumkur, Karnataka, India. The duration of the study was one year from August 1, 2019, to August 1, 2020. A total of 100 patients with atonic PPH were randomly assigned to receive either BUAL (group BUAL-50 patients) or B-lynch sutures (group B-lynch-50 patients). Age, parity, gravidity, socioeconomic status, and risk factors were compared. The mean drop in Haemoglobin (Hb) percentage, the need for blood transfusion, and complications were studied and analysed. The success of the method was defined as avoiding obstetric hysterectomy and major complications. The z-test was used to calculate the difference between the means of the two groups. Results: The mean age of the patients was 25.22±4.33 years in the BUAL group and 26.02±4.32 years in the B-lynch group. During the one-year study period, the total number of deliveries in the Institution was 4,658, with 1,864 vaginal deliveries and 2,794 LSCS performed. Among the 2,794 LSCS cases, 268 women (9.58%) developed primary PPH. Out of these 268 women, 134 (50%) were managed with primary medical treatment for atonic PPH. For those who did not respond to primary medical management and met the inclusion and exclusion criteria, 50 women underwent BUAL and were assigned to the BUAL group. Another 50 cases were treated with B-lynch sutures and assigned to the B-lynch group. The patients in both groups were matched in terms of age, socio-economic status, booking status, gestational age at delivery, induction of labour, and high-risk factors for PPH. Maternal outcomes were analysed. The mean preoperative Hb level was 9.65±1.16 g/dL, which significantly decreased to 8.54±1.27 g/dL post-procedure in the BUAL group (p-value <0.001). In the B-lynch group, the mean preoperative Hb level was 9.68±0.85 g/dL, which significantly decreased to 8.52±0.95 g/dL post-procedure (p-value <0.001). The mean blood loss among patients was 1312.14±227.65 mL in the BUAL group and 1359.22±259.07 mL in the B-lynch group, but the difference was not statistically significant (p-value = 0.33). In the present study, 17 patients (34%) in the BUAL group and 21 patients (42%) in the B-lynch group did not require blood transfusion. The Intensive Care Unit (ICU) care was necessary for 6 (12%) patients in the BUAL group and 8 (16%) in the B-lynch group. Postoperative fever was a common complication in both groups. The success rate of BUAL was 94%, while the B-lynch procedure was successful in 96% of cases. Conclusion: The PPH a significant concern for obstetricians, and effective and meticulous management is crucial in reducing maternal mortality. Both BUAL and B-lynch sutures are simple, safe, and effective methods for controlling PPH during caesarean section by uterine devascularisation.

Keywords

• complications
• maternal mortality
• success
• uterine devascularisation