The blynch suture, also known as the brace suture, was described by christopher b lynch and coworkers in 1997 as an alternative surgical method of controlling postpartum haemorrhage due to uterine atony. Sep 03, 2016 nilson and birch 2006 after a cesarean section a large needle with no 2 vicryl thread was inserted 2 cm below the uterine incision in similar manner to blynch technique and then brought up vertically and exits the anterior wall 2cm above the uterine incision, then the suture was passed through the fundus 34 cm medial tp cornual. In case of failure of the blynch uterine compression sutures, biial may be beneficial to save the uterus. It is used to mechanically compress an atonic uterus in the face of severe postpartum hemorrhage. The main indication to perform a uterine compression suture is the hemorrhage due to uterine atony, but can be performed in all circumstances in which its.
The protocol consists of preventive radiological catheterization of the descending aorta, cesarean delivery, use of affronti endouterine square hemostatic sutures, and placement of an intrauterine bakri balloon in conjunction with blynch suture. Blynch suture techniques, giving bad news to a patient and her family and appropriate documentation of a shoulder dystocia delivery note. Pdf the blynch technique for the management of intraoperative. Manual massage of the uterus and administration of oxytocin, misoprostol. Pericardium suture retention strength ta instruments. The definitive guide to dental suturing and surgical flap closure, 2011, lee h. The most commonly described technique of modified blynch suture may not be suitable for all the patients presenting with flabby, atonic uterus.
Comparison of postoperative complications between blynch suture and obstetric hysterectomy complications blynch sutureobstetric hysterectomy major vasicovaginal 2 fistula deep venous 1 thrombosis maternal mortality 2 minor fever 05 10 wound gape 03 06. Less clear is the effect of closure material on the incidence of noninfectious wound complications. Christopher blynch was the first to highlight this revolutionary principle, and other uterine compression suture techniques have since been described by hayman and cho. Participants were asked to complete an anonymous survey provided as supplemental online material. Combining multiple procedures generally requires an overnight stay at the hospital for your safety, and most people like having access to iv meds and a caring registered nurse to help with whatever needs they may have. Pdf blynch suture for the treatment of uterine atony. The blynch suture or b lynch procedure is a form of compression suture used in obstetrics. Lyndon a, lagrew d, shields l, melsop k, bingham b, main e eds. Between 4 and 6 affronti sutures are used depending on the severity of bleeding. The utility of the blynch suture is attributed to its simplicity, safety, ability to preserve life, the uterus and fertility with the benefit of immediate evaluation of hemostatic success 37 of the 60 published case reports in which the blynch suture was used, only one negative outcome uterine necrosis was documented 38. During the placement of suture, patient was placed in frogleg position to assess the compression effect of blynch suture. Technique b lynch suture for uterine atony register now, join the community for free access.
Overall success rate of the b lynch sutures and b lynch sutures plus biial was 75 and 94. Objectives stepbystep description of the b lynch brace suture and discussion of the current compression suture techniques. Improving health care response to obstetric hemorrhage toolkit. A retrospective analysis of twelve patients with uncontrolled postpartum haemorrhage, who underwent this procedure from march 2007 to september 2012, was conducted. Pdf this paper reports the experience of 150 blynch suture applications for the management of uterine atony during. Pericardium suture retention strength figure 1 pericardium sample prior to testing. The b lynch suture is a form of compression suture used to mechanically compress an atonic uterus in the face of severe postpartum hemorrhage. The survey collected physician demographics resident and level, fellow and level, attending physician and years of experience, level of understanding of the b lynch suture, confidence in performing it 1 low, 5 high, and whether they had ever performed it before. Learn vocabulary, terms, and more with flashcards, games, and other study tools. As regards management options, blynch brace suture, and its modifications have been used for. Blynch suture demonstration by prof b lynch and dr javaid. Medicare replacement pdf download medicare benefits pdf download medicare part b pdf download b lynch suture cpt code. Loop of suture was at least 2 mm from end of sample. Christopher b lynch was the first to highlight this revolutionary principle, and other uterine compression suture techniques have since been described by hayman and cho.
For the contribution history and old versions of the redirected article, please see its history. Blynch suture classical modified form was applied in 75 cases. Placing an intrauterine bakri balloon in conjunction with the blynch uterine compression suture. A b lynch suture is a suturing technique to brace and stabilize the uterus in cases of severe postpartum hemorrhage.
Jun 09, 2010 nevertheless, and although we have reported successful pregnancies following b lynch suture combined with other uterinesparing procedures 45, we do believe that uterine artery ligation, which is a wellassessed procedure, and as simple, rapid, and effective as b lynch suture 3, should currently be the firstline uterinesparing surgical. To simulate a blynch compression suture, we use neoprene models. The blynch suture or blynch procedure is a form of compression suture used in obstetrics. Role of modified blynch suture in modern day management of.
Subsequent pregnancy outcome after blynch suture placement. Nilson and birch 2006 after a cesarean section a large needle with no 2 vicryl thread was inserted 2 cm below the uterine incision in similar manner to blynch technique and then brought up vertically and exits the anterior wall 2cm above the uterine incision, then the suture was passed through the fundus 34 cm medial tp cornual. There are many ways to suture as far as how the sutures are laid out interrupted, mattress, continuous, etc. The discussion was closed on 30 september 2012 with a consensus to merge. Sep 11, 20 b lynch suture demonstration by prof b lynch and dr javaid. The survey collected physician demographics resident and level, fellow and level, attending physician and years of experience, level of understanding of the blynch suture, confidence in performing it 1 low, 5 high, and whether they had ever performed it before. Participants will be separated into groups of 10 rotate through the team simulation on day 1 and the task training stations on day 2. Simple suturing covers most situations body modification artists need to face if you become fluid in the instrument knot, that will cover 99% of. To evaluate whether use of the blynch suture is associated with subsequent adverse pregnancy outcomes. Blynch uterine compression sutures in the conservative.
May 03, 2020 a b lynch suture is a suturing technique to brace and stabilize the uterus in cases of severe postpartum hemorrhage. One advantage of this technique is that it conserves fertility so that the patient can have more children in the future. The blynch suture technique professor christopher blynch. The b lynch technique does not necessarily require specific suture material. Pfannenstiel incision or reopen previous caesarean skin incision. Technique blynch suture for hemorragia postparto video.
The most commonly described technique of modified b lynch suture may not be suitable for all the patients presenting with flabby, atonic uterus. Transverse compression suture to control bleeding fro pph placenta previa by prof blynch duration. To evaluate whether use of the b lynch suture is associated with subsequent adverse pregnancy outcomes. The suture should be more or less vertical and lying about 4 cm from the cornua figure 1. The blynch surgical technique for the control of massive. Transactions, volume 5 transactions, ephraim shorr, b.
To simulate a b lynch compression suture, we use neoprene models. Blynch suture demonstration by prof blynch youtube. B lynch suture is an efficient, safe, and simple method for the treatment of primary postpartum hemorrhage during cesarean section, which successfully reduces the number of urgent postpartum hysterectomies, also preserving subsequent fertility. Cheat sheet 1 2 5 3 6 4 7 pass the center of the sutureloop over the free end of. Role of modified blynch suture in modern day management. Technique blynch suture for uterine atony register now, join the community for free access. Figure 3 time sequence of loaded sample from initial preload to near failure. Most published data discuss the original blynch suture, whose. Sutures versus staples for wound closure in orthopaedic.
In 1997, christopher b lynch reported 1 on the first widely utilized uterine compression suture. B lynch compression suture as an alternative to paripartum hysterectomy b lynch suture illustration of technique fallopian tube suture passing over posterior uterine surface bite of suture section hysterotomy 4 cm 3 cm 3 cm fallopian tube same level as the upper anterior entry point b round ligament. Alternative compression sutures have been reported by hayman, 2 pereira, 3 and others. The blynch technique does not necessarily require specific suture material. Leslie carranza, md, mhs susan leong kee, md obstetrical. The b lynch suturing technique brace suture may be particularly useful because of its simplicity of application, life saving potential, relative safety, and its capacity for preserving the uterus and thus fertility. C b lynch et al b lynch brace suture alternative to hysterectomy surgical technique for the control of massive postpartum haemorrhage. Also, removing sutures prevents joining of endometrial walls over. Aug 14, 2010 b lynch suture classical modified form was applied in 75 cases. The utility of the b lynch suture is attributed to its simplicity, safety, ability to preserve life, the uterus and fertility with the benefit of immediate evaluation of hemostatic success 37 of the 60 published case reports in which the b lynch suture was used, only one negative outcome uterine necrosis was documented 38. The blynch suturing technique brace suture may be particularly useful because of its simplicity of application, life saving potential, relative safety, and its capacity. Erosion of suture through the uterine wall can be a complication of the b lynch uterine suture brace. Uterine compression suture technique in the management of.
Closure of midline abdominal incisions with small stitches. This is a cohort study of women who experienced postpartum hemorrhage between january 2000 and june 2010 and had a subsequent pregnancy at. A retrospective study of 9 patients with placenta previa accreta who underwent a conservative management protocol. During the placement of suture, patient was placed in frogleg position to assess the compression effect of b lynch suture.
Chapter 11 wound healing and sutures flashcards quizlet. Modified blynch suture 31 obstetric hysterectomy 36 table 2. Blynch suture, intrauterine balloon, and endouterine. The invention of the blynch brace suturing technique has proved invaluable in the control of massive post partum haemorrhage pph as. The pereira sutures combine longitudinal and transverse sutures placed as a. In the spectrum of surgical decisionmaking, wound closure material is often an afterthought. The procedure was initially described using chromic catgut, but the consultants in our department used a variety of other sutures, such as pds polydioxanone in one case and vicryl polyglactin 910 in the rest. In addition, sutures may be placed through the skin as well as being entirely buried. Uterine devascularization or biial did not increase the risk of the possible shortterm complications such as uterine necrosis.
Definitive guide to dental suturing and surgical flap closure factors regulating blood pressure. Place the patient in the lloyd davies position and pass indwelling urinary catheter. Successful of the blynch compression suture in the. Successful use of the blynch uterine compression suture. However, the findings of a recent metaanalysis suggest that the rate of surgical site infections ssis is increased by using staples to close surgical wounds. A blynch suture is a suturing technique to brace and stabilize the uterus in cases of severe postpartum hemorrhage. We read with great interest the case reported by goojha et al.
Reliability can be increased by combining this assessment score with others. Blynch compression suture as an alternative to paripartum. Figure 2 loaded sample top view with the sample and suture ends gripped by lightweight tensile grips. In our office, sabrina, our patient care coordinator, is awesome at coordinating multiple surgeons with crazy schedules. While practicing on these models, trainees discuss the indications for blynch, learn the correct suture material, and develop tactical. B lynch suture techniques, giving bad news to a patient and her family and appropriate documentation of a shoulder dystocia delivery note.
Suture sizes are given by a number representing diameter ranging in descending order from 10 to 1 and then 1o to 12o, 10 being the largest and 12o being the smallest at a diameter than a human hair anand, 2006. C blynch et al b lynch brace suture alternative to hysterectomy surgical technique for the control of massive postpartum haemorrhage. The blynch, hayman, and pereira uterine compression sutures. Sutureloop whip stitch technique graft preparation using the sutureloop whip stitching technique significantly reduces graft preparation time. A new removable uterine compression by a brace suture in the.
A retrospective study of data of all women who delivered between may 2004 and june 2007 was collected from the departments database, to identify patients who had undergone the b lynch procedure. Please blynch suturespat posted mon 21st of february, 2011 04. The blynch and other uterine compression suture techniques. Technical description of the blynch brace suture for. Us9687221b2 us14179,438 us201414179438a us9687221b2 us 9687221 b2 us9687221 b2 us 9687221b2 us 201414179438 a us201414179438 a us 201414179438a us 9687221 b2 us9687221 b2 us 9687221b2 authority us united states prior art keywords suture anchor bone limb method prior art date 202 legal status the legal status is an assumption and is not a legal conclusion. The invention of the b lynch brace suturing technique has proved invaluable in the control of massive post partum haemorrhage pph as. Successful term delivery after khairys modified blynch suture. Placing an intrauterine bakri balloon in conjunction with the blynch uterine compression suture was successful in. Shatz, david kurtzman, 0979864623, 9780979864629, aegis communications, 2011. Satisfactory haemostasis can be assessed immediately after application. Sep 08, 20 transverse compression suture to control bleeding fro pph placenta previa by prof b lynch duration. Delayed, absorbable suture is less desirable than absorbable suture for this procedure due to.
It was developed by christopher b lynch, a consultant obstetrician and gynaecological surgeon based at milton keynes general hospital, milton keynes, buckinghamshire, england. Towel uterus model for uterine compression sutures technical. The blynch suture is a form of compression suture used to mechanically compress an atonic uterus in the face of severe postpartum hemorrhage. Erosion of suture through the uterine wall can be a complication of the blynch uterine suture brace. The blynch suture technique professor christopher b. It has been recommended to place stitches at least 10 mm from the wound edge. Bimanual compression to test for potential success. Recent studies, taking the sl to wl ratio into account, have shown that a stronger wound is produced with small stitches placed closer to the wound edge.
Since the first publication of blynch technique in 1997 4, different uterine. This procedure is named for the surgeon who invented it, christopher b. The b lynch suture or b lynch procedure is a form of compression suture used in obstetrics. Blynch suture is an efficient, safe, and simple method for the treatment of primary postpartum hemorrhage during cesarean section, which successfully reduces the number of urgent postpartum hysterectomies, also preserving subsequent fertility. It was developed by christopher b lynch, a consultant obstetrician and gynaecological surgeon based at milton keynes general hospital, milton keynes. In the present study, out of the 24 cases table 1 in which the blynch suture was attempted by skilled operators. The method is simple and seems to be effective, although only case reports are available to evaluate the efficacy of the procedure. Every obstetrician should be proficient with the placement of at least one uterine compression suture for the treatment of pph caused by uterine atony. C blynch et al blynch brace suture alternative to hysterectomy surgical technique for the control of massive postpartum haemorrhage. A novel approach to teaching placement of a blynch suture. It was developed by christopher blynch, a consultant obstetrician and gynaecological surgeon based at milton keynes general hospital, milton keynes, buckinghamshire, england. Objectives stepbystep description of the blynch brace suture and discussion of the current compression suture techniques. Successful use of the blynch uterine compression suture in. For a major placenta praevia an independent figureeight suture can be placed anteriorly or posteriorly or both prior to application of the blynch suture as described above, if necessarily.