Comparative Study of Bilateral Uterine Artery Ligation Versus B-Lynch Suture in Primary Postpartum Hemorrhage Following Lower Segment Cesarean Section: A Prospective Single-Center Analysis

TL;DR

This study compares two surgical methods for treating heavy bleeding after C-sections and finds they are equally effective and safe.

Contribution

The study provides a direct comparison of BUAL and B-Lynch sutures for PPH management after LSCS in a single-center setting.

Findings

BUAL and B-Lynch sutures showed no significant difference in intraoperative blood loss.

Both methods had similar maternal satisfaction and hospital stay durations.

Subgroup analyses confirmed consistent results across delivery modes and atony severity.

Abstract

Background

Primary postpartum hemorrhage (PPH) remains a significant challenge in obstetric practice, contributing to maternal morbidity and mortality worldwide. Characterized by excessive bleeding within the first 24 hours following childbirth, PPH is a leading cause of maternal death. Uterine atony, inadequate contraction of the uterine muscle, accounts for the majority of PPH cases, particularly following lower segment cesarean section (LSCS). Bilateral uterine artery ligation (BUAL) and B-Lynch sutures have emerged as surgical interventions for managing PPH secondary to uterine atony during LSCS. Despite their demonstrated efficacy, comparative studies are needed to determine the optimal approach.

Methods

This prospective, comparative study was conducted among women experiencing primary postpartum hemorrhage (PPH) due to uterine atony following lower segment cesarean section (LSCS) over two years at a tertiary care hospital in India. A total sample size of 86 participants (43 per group) was determined using a convenient sampling technique within the defined study period. Participants were randomized into two groups: the BUAL group and the B-Lynch suture group. The primary outcome was intraoperative blood loss (ml). Statistical analysis was conducted using IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp., with significance set at p < 0.05.

Results

The mean age of study participants was 28.6 years (± 4.2) in the BUAL group and 29.1 years (± 4.6) in the B-Lynch suture group, demonstrating no significant difference (p = 0.563). Furthermore, the length of hospital stay was comparable between the BUAL and B-Lynch suture groups (p = 0.667). Maternal satisfaction, indicated by the proportion of satisfied participants, was high in both groups, with no significant difference observed (p = 0.682). Subgroup analyses based on the mode of delivery and severity of uterine atony within the BUAL and B-Lynch suture groups showed no significant differences in intraoperative blood loss (p-values ranging from 0.491 to 0.802).

Conclusion

In conclusion, both BUAL and B-Lynch sutures demonstrate comparable efficacy and safety in managing primary postpartum hemorrhage (PPH) due to uterine atony following lower segment cesarean section (LSCS). Further large-scale studies are warranted to validate these findings and inform evidence-based clinical practice in managing PPH during LSCS.