Efficacy of Bilateral Uterine Artery Ligation versus Uterine Flexion Suture (Modified B-Lynch) In Treatment of Primary Atonic Postpartum Hemorrhage. Randomized Controlled Trial

Abstract

terine atony is the most common cause of primary postpartum hemorrhage (PPH), which is one of the leading causes of maternal mortality and it is common following both vaginal and caesarean delivery. Management of PPH due to uterine atony may end with emergency hysterectomy, which is considered the last step to control bleeding. Before hysterectomy, uterine atony is usually treated by medications such as oxytocin, ergometrine, misoprostol, or sulprostone and if failed uterus-sparing surgery should be done first as intrauterine balloon tamponade, B-LYNCH, modified compression sutures, bilateral ligation of uterine arteries and bilateral ligation of internal iliac arteries. Primary PPH occurs within 24 hours of delivery. It is defined by a reduction in the patient’s hematocrit level by more than 10% of the prenatal value or blood loss causing hemodynamic instability of sufficient seriousness to require blood transfusion. Most cases (83%) of PPH are due to uterine atony. The causes of uterine atony are general anesthesia, over distended uterus with multiple fetuses, excessive amniotic fluid, prolonged labor; oxytocin induced or augmented labor, grand multiparity, history of prior uterine atony, chorioamnionitis