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Xiang J, Chen F, Cai Z, Bao R. A rare case of fundal intramural ectopic pregnancy associated with previous B-Lynch sutures. BMC Womens Health 2024; 24:210. [PMID: 38566024 PMCID: PMC10986008 DOI: 10.1186/s12905-024-03027-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 03/15/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Intramural ectopic pregnancy is a rare form of ectopic pregnancy that occurs within the myometrium. It is challenging to diagnose it early because of its nonspecific clinical presentation, and there is no consensus or guideline on the optimal management among gynecologists. CASE PRESENTATION We report a case of a 34-year-old woman who developed fundal intramural ectopic pregnancy after a previous caesarean section with B-Lynch suture. The B-Lynch suture was performed at 38 weeks of gestation for postpartum hemorrhage caused by refractory uterine atony about 8 years ago. Since then, the patient had oligomenorrhea. The diagnosis of intramural ectopic pregnancy was not confirmed by magnetic resonance imaging or ultrasound. An exploratory laparoscopy and hysteroscopy was performed to remove the gestational sac without significant bleeding. The surgery was successful and the patient recovered well. The patient was advised to monitor her β-HCG levels regularly until they returned to normal, and a follow-up pelvic ultrasound showed no complications. However, she has not been able to conceive or have an ectopic pregnancy so far. CONCLUSIONS This case illustrates the difficulty of diagnosing intramural ectopic pregnancy, especially when it is associated with previous uterine surgery and B-Lynch suture. It also demonstrates the feasibility and safety of laparoscopic surgery for treating complete IUP, especially when the gestational sac is located close to the uterine serosa. However, the risk of uterine rupture and hemorrhage should be considered, and the patient should be informed of the possible complications and alternatives. Gynecologists should be familiar with various management strategies and customize the treatment plan according to the patient's clinical situation and preferences.
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Affiliation(s)
- Junmiao Xiang
- Department of Gynecology, Ruian People's Hospital, Wangsong Road, Ruian, 325000, Zhejiang, China.
| | - Fendang Chen
- Department of Gynecology, Ruian People's Hospital, Wangsong Road, Ruian, 325000, Zhejiang, China
| | - Zhuhua Cai
- Department of Gynecology, Ruian People's Hospital, Wangsong Road, Ruian, 325000, Zhejiang, China
| | - Ruru Bao
- Department of Ultrasonography, Ruian People's Hospital, Wangsong Road, Ruian, 325000, Zhejiang, China
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Lu X, Zhang H, Wu X, Chen X, Zhang Q, Song W, Jin Y, Yuan M. The value of the combined MR imaging features and clinical factors Nomogram model in predicting intractable postpartum hemorrhage due to placenta accreta. Medicine (Baltimore) 2024; 103:e37665. [PMID: 38552054 PMCID: PMC10977557 DOI: 10.1097/md.0000000000037665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 02/29/2024] [Indexed: 04/02/2024] Open
Abstract
To explore the value of the combined MR imaging features and clinical factors Nomogram model in predicting intractable postpartum hemorrhage (IPH) due to placenta accreta (PA). We conducted a retrospective study with 270 cases of PA patients admitted to our hospital from January 2015 to December 2022. The clinical data of these patients were analyzed, and they were divided into 2 groups: the IPH group and the non-IPH group based on the presence of IPH. The differences in data between the 2 groups were compared, and the risk factors for IPH were analyzed. A Nomogram model was constructed using independent high-risk factors, and the predictive value of this model for IPH was analyzed. The results of multivariable binary Logistic regression analysis showed higher number of cesareans, placenta previa, placenta accreta type (implantation, penetration), low signal strip on T2 weighted image (T2WI) were independent high-risk factor for IPH (P < .05). ROC analysis and Hosmer-Lemeshow goodness-of-fit test showed the Nomogram predictive model constructed with the high-risk factor has good discrimination and calibration. Decision curve analysis (DCA) showed that when the probability threshold for the Nomogram model's prediction was in the range from 0.125 to 0.99, IPH patients could obtain more net benefits, making it suitable for clinical application. The higher number of cesareans, placenta previa, placental accreta type (implantation, penetration), and low signal strip on T2WI are independent high-risk factor for IPH. The Nomogram predictive model constructed with the high-risk factor demonstrates good clinical efficacy in predicting the occurrence of IPH due to PA.
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Affiliation(s)
- Xian Lu
- Department of Radiology, Affiliated Maternity and Child Health Care Hospital of Nantong University, Nantong, China
| | - Haibo Zhang
- Department of Emergency Medicine, Affiliated Maternity and Child Health Care Hospital of Nantong University, Nantong, China
| | - Xianhua Wu
- Department of Radiology, Affiliated Hospital of Nantong University, Nantong, China
| | - Xianfeng Chen
- Department of Ultrasound, Affiliated Maternity and Child Health Care Hospital of Nantong University, Nantong, China
| | - Qin Zhang
- Department of Radiology, Affiliated Maternity and Child Health Care Hospital of Nantong University, Nantong, China
| | - Wei Song
- Department of Radiology, Affiliated Maternity and Child Health Care Hospital of Nantong University, Nantong, China
| | - Yanqi Jin
- Department of Obstetrics, Affiliated Maternity and Child Health Care Hospital of Nantong University, Nantong, China
| | - Mingming Yuan
- Department of Pathology, Affiliated Maternity and Child Health Care Hospital of Nantong University, Nantong, China
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Daniyal L. Intrauterine Adhesions in Response to Pelvic Inflammatory Disease Due to Change in Vaginal Microecology [Letter]. Int J Womens Health 2023; 15:1623-1624. [PMID: 37908285 PMCID: PMC10615102 DOI: 10.2147/ijwh.s442745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/23/2023] [Indexed: 11/02/2023] Open
Affiliation(s)
- Laraib Daniyal
- Department of Obstetrics and Gynaecology, Abbasi Shaheed Hospital, Karachi, Pakistan
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Archana C, Rashmi M, Amita S. Early Uterine Necrosis due to Modified B-Lynch Suture. J Obstet Gynaecol India 2022; 72:95-97. [PMID: 35125748 PMCID: PMC8804011 DOI: 10.1007/s13224-020-01393-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/29/2020] [Indexed: 02/03/2023] Open
Abstract
B-lynch compression sutures, applied as a life-saving procedure in cases of atonic postpartum haemorrhage can sometimes lead to life-threatening complications. We report a case of early uterine necrosis following B-lynch compression suture application for PPH at the time of LSCS, resulting in peripartum hysterectomy.
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Affiliation(s)
- Chaudhary Archana
- Department of Obst. and Gynae, GTB Hospital, Dilshad Garden, New Delhi, India
| | - Malik Rashmi
- Department of Obst. and Gynae, GTB Hospital, Dilshad Garden, New Delhi, India
| | - Suneja Amita
- Department of Obst. and Gynae, GTB Hospital, Dilshad Garden, New Delhi, India
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Vanwinkel S, Claes L, Van den Bosch T. Obstetrical outcome after B-Lynch sutures and ligation of uterine arteries: A case report. Case Rep Womens Health 2021; 30:e00303. [PMID: 33777709 PMCID: PMC7985276 DOI: 10.1016/j.crwh.2021.e00303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 02/27/2021] [Accepted: 03/03/2021] [Indexed: 11/26/2022] Open
Abstract
Objective To illustrate the obstetrical outcome after B-Lynch sutures and ligation of the uterine arteries. Case A 26-year-old nulliparous woman. A caesarean section performed for obstructed labour was complicated by uterine atony. A B-Lynch uterine compression suture technique was used combined with ligation of the ascending branches of the uterine arteries. Before the subsequent fertility treatment, gel instillation sonography and power Doppler imaging showed a normal uterine cavity and restored myometrial vascularization. Subsequent caesarean section showed external adhesions on the anterior uterine serosa. A healthy baby of normal weight was delivered. There was focal placenta accreta; the underlying myometrium was strikingly thinner and prone to inversion. Discussion After B-Lynch sutures and ligation of the ascending branches of the uterine arteries, the pregnancy was subsequently uncomplicated. The potential association between B-Lynch sutures and placenta accreta or uterine inversion in a subsequent pregnancy has to be assessed in further studies. This case report illustrates how 3D gel instillation sonography is a valuable tool to evaluate the integrity of the uterine cavity. 3D gel instillation sonography gives the best evaluation of the uterus after B-Lynch sutures have been used. Normal fertility and pregnancy are possible after B-Lynch sutures have been used. Normal fertility and pregnancy are possible after ligation of the uterine arteries. B-Lynch sutures and ligation of the uterine arteries are useful in postpartum haemorrhage.
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Affiliation(s)
- S Vanwinkel
- Department of Obstetrics and Gynaecology, University Hospitals UZ Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - L Claes
- Department of Obstetrics and Gynaecology, Regional Hospital RZ Tienen, Kliniekstraat 45, 3300 Tienen, Belgium
| | - T Van den Bosch
- Department of Obstetrics and Gynaecology, University Hospitals UZ Leuven, Herestraat 49, 3000 Leuven, Belgium.,Laboratory for Tumor Immunology and Immunotherapy KU Leuven, Herestraat 49, 3000 Leuven, Belgium
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The Discriminant Use of Intrauterine Balloon Tamponade and Compression Sutures for Management of Major Postpartum Hemorrhage: Comparison of Patient Characteristics and Clinical Outcome. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6648829. [PMID: 33490275 PMCID: PMC7801069 DOI: 10.1155/2021/6648829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 11/17/2022]
Abstract
Background Intrauterine balloon tamponade (IUBT) and compression sutures have been widely used in recent years in the management of postpartum hemorrhage (PPH). However, there is scant literature directly comparing the clinical scenarios that led to the discriminant selection of these management modalities and the direct clinical outcomes. The purpose of this study is to compare the patient characteristics and clinical risk factors that led to the use of IUBT and compression sutures in the management of major PPH as well as the immediate outcome in a retrospective cohort. Methods Patients who had IUBT or compression sutures applied due to major PPH (>1000 ml) from 2014 to 2018 in a single obstetric unit were recruited. The patient characteristics and clinical outcome of the two groups were compared. Results A total of 67 patients had IUBT and 29 patients had compression sutures applied as the first uterine sparing technique. Apart from more vaginal deliveries (25.4% vs. 3.5%) in the IUBT group compared to compression sutures, there were no significant differences between the two groups in terms of patient characteristics. The IUBT group had a slightly higher blood loss at the start of the uterine sparing procedure (239 ml, p = 0.049) and received more transfusions, despite no differences in the total blood loss, hemogloblin level, incidence of coagulopathy, and intensive care unit admission between the two groups. There was no significant difference in the overall success rate between IUBT and compression sutures to control PPH without additional surgical intervention or hysterectomy (73.1% vs. 55.1%, p = 0.15) or the success rate for PPH due to uterine atony (32.8% vs. 20.7%), though IUBT apparently performed better than compression sutures in cases of placenta praevia (77.3% vs. 16.7%, p = 0.01). Blood loss > 1.5 l at the start of the procedure, presence of placenta accreta, and presence of coagulopathy were found to be significant poor prognostic factors for both procedures to control PPH. Conclusions There were no dominating patient characteristics that favoured the selection of either IUBT or compression sutures in the management of severe PPH except for the mode of delivery. Both procedures had equally high overall success rates to control PPH, but IUBT performed better in placenta praevia cases as compared to compression sutures.
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Doroftei B, Dabuleanu AM, Ilie OD, Maftei R, Anton E, Simionescu G, Matei T, Armeanu T. Mini-Review of the New Therapeutic Possibilities in Asherman Syndrome-Where Are We after One Hundred and Twenty-Six Years? Diagnostics (Basel) 2020; 10:diagnostics10090706. [PMID: 32957624 PMCID: PMC7554703 DOI: 10.3390/diagnostics10090706] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/08/2020] [Accepted: 09/16/2020] [Indexed: 02/03/2023] Open
Abstract
Asherman syndrome is a multifaceted condition describing the partial or complete removal of the uterine cavity and/or cervical canal. It is a highly debatable topic because of its pronounced influence on both reproductive outcomes and gynaecologic symptoms. The latest reports demonstrated that trauma to the endometrium is the main cause of intrauterine adhesion formation. Left untreated, such adhesions gradually lead to a range of repercussions ranging from mild to severe. Considering the lack of non-invasive approaches, the advent of hysteroscopy has revolutionized the entire field, being otherwise considered the most efficient tool offering new directions and amplifying the chances of treating the Asherman syndrome.
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Affiliation(s)
- Bogdan Doroftei
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (B.D.); (A.-M.D.); (R.M.); (E.A); (G.S.)
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, No. 34, 700038 Iasi, Romania; (T.M.); (T.A.)
- Origyn Fertility Center, Palace Street, No. 3C, 700032 Iasi, Romania
| | - Ana-Maria Dabuleanu
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (B.D.); (A.-M.D.); (R.M.); (E.A); (G.S.)
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, No. 34, 700038 Iasi, Romania; (T.M.); (T.A.)
- Origyn Fertility Center, Palace Street, No. 3C, 700032 Iasi, Romania
| | - Ovidiu-Dumitru Ilie
- Department of Research, Faculty of Biology, Alexandru Ioan Cuza University, Carol I Avenue, No. 20A, 700505 Iasi, Romania
- Correspondence:
| | - Radu Maftei
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (B.D.); (A.-M.D.); (R.M.); (E.A); (G.S.)
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, No. 34, 700038 Iasi, Romania; (T.M.); (T.A.)
- Origyn Fertility Center, Palace Street, No. 3C, 700032 Iasi, Romania
| | - Emil Anton
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (B.D.); (A.-M.D.); (R.M.); (E.A); (G.S.)
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, No. 34, 700038 Iasi, Romania; (T.M.); (T.A.)
- Origyn Fertility Center, Palace Street, No. 3C, 700032 Iasi, Romania
| | - Gabriela Simionescu
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (B.D.); (A.-M.D.); (R.M.); (E.A); (G.S.)
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, No. 34, 700038 Iasi, Romania; (T.M.); (T.A.)
- Origyn Fertility Center, Palace Street, No. 3C, 700032 Iasi, Romania
| | - Theodor Matei
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, No. 34, 700038 Iasi, Romania; (T.M.); (T.A.)
- Origyn Fertility Center, Palace Street, No. 3C, 700032 Iasi, Romania
| | - Theodora Armeanu
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, No. 34, 700038 Iasi, Romania; (T.M.); (T.A.)
- Origyn Fertility Center, Palace Street, No. 3C, 700032 Iasi, Romania
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Mishra A, Dash S, Rath SK. B-Lynch Resulting in Total Uterine Necrosis Leading to Obstetric Hysterectomy. J Obstet Gynaecol India 2019; 69:4-6. [PMID: 30956480 DOI: 10.1007/s13224-017-1068-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 10/26/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Abhipsa Mishra
- Department of Obstetrics and Gynaecology, KIMS Hospital, Bhubaneswar, Odisha India
| | - Sudarshan Dash
- Department of Obstetrics and Gynaecology, KIMS Hospital, Bhubaneswar, Odisha India
| | - Sudhansu Kumar Rath
- Department of Obstetrics and Gynaecology, KIMS Hospital, Bhubaneswar, Odisha India
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Abstract
Intrauterine adhesions with symptoms like hypomenorrhea or infertility are known under the term Asherman's syndrome. Although the syndrome has been widely investigated, evidence of both prevention of the syndrome and the ideal treatment are missing. Understanding the pathogenesis of intrauterine adherences is necessary for the prevention of the formation of intrauterine scarring. Intrauterine adhesions can develop from lesion of the basal layer of the endometrium caused by curettage of the newly pregnant uterus. The syndrome may also occur after hysteroscopic surgery, uterine artery embolization or uterine tuberculosis. For initial diagnosis the less invasive contrast sonohysterography or hysterosalpingography is useful. The final diagnosis is based on hysteroscopy. Magnetic resonance imaging is required in cases with totally obliterated uterine cavity. Intrauterine adherences are classified in accordance with different classification systems based on the hysteroscopic diagnosis of severity and localization of adherences. Classification is necessary for the planning of surgery, information on prognosis and scientific purposes. Surgery is performed in symptomatic patients with either infertility or with painful periods. Intrauterine adherences are divided with a hysteroscope using scissors or a power instrument working from the central part of the uterus to the periphery. Peroperative ultrasonography is useful in an outpatient setting for the prevention of complications. Hysteroscopy with fluoroscopy is a solution in difficult cases. Use of intrauterine devices like balloon catheters or intrauterine contraceptive devices seems to be the preferred methods for the prevention of re-occurrence of adhesions after treatment. Both primary prevention after hysteroscopic surgery or curettage and secondary prevention of new adhesions after adhesiolysis have been investigated. The aim of this review was to summarize the literature on diagnosis, classification, treatment and prevention, based on a literature search with a wide range of search terms.
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Affiliation(s)
- Eva Dreisler
- Department of Gynecology, The Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark,
| | - Jens Joergen Kjer
- Department of Gynecology, The Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark,
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Egashira K, Hiasa K, Yokota N, Kawamura T, Matsushita T, Okugawa K, Yahata H, Sonoda K, Kato K. Infertility after abdominal trachelectomy. Acta Obstet Gynecol Scand 2018; 97:1358-1364. [DOI: 10.1111/aogs.13429] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 07/03/2018] [Accepted: 07/10/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Katsuko Egashira
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Kana Hiasa
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Natsuko Yokota
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Teruhiko Kawamura
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Tomoko Matsushita
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Kaoru Okugawa
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Hideaki Yahata
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Kenzo Sonoda
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Kiyoko Kato
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
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Successful term delivery after Khairy’s modified B-lynch suture technique: First case report. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2017. [DOI: 10.1016/j.mefs.2016.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kaya B. Reply to: Bakri balloon vs. B-Lynch suture as hemostatic procedures for atonic bleeding: clarifications and concerns. Arch Gynecol Obstet 2016; 293:1149-51. [PMID: 26993516 DOI: 10.1007/s00404-016-4064-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 02/16/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Baris Kaya
- Department of Obstetrics and Gynecology, Near East University Faculty of Medicine, Lefkosa-TRNC, Mersin 10, Turkey.
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13
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Which uterine sparing technique should be used for uterine atony during cesarean section? The Bakri balloon or the B-Lynch suture? Arch Gynecol Obstet 2016; 294:511-7. [DOI: 10.1007/s00404-016-4015-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 01/05/2016] [Indexed: 10/22/2022]
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Tadakawa M, Sugawara J, Saito M, Nishigori H, Utsunomiya H, Nagase S, Tokunaga H, Kurakata-Nakamura M, Sugiyama T, Yaegashi N. Fertility and pregnancy outcomes following B-Lynch sutures for post-partum hemorrhage. J Obstet Gynaecol Res 2014; 41:559-64. [PMID: 25331482 DOI: 10.1111/jog.12590] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 08/10/2014] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to investigate the long-term fertility prognosis after B-Lynch sutures for post-partum hemorrhage (PPH). METHODS A retrospective observational study was conducted on patients who underwent B-Lynch sutures in our hospital between 2005 and 2010. Patient data was collected from hospital records. Information regarding subsequent pregnancies and menstrual complications were obtained by posted questionnaires and telephone interviews with patients who avoided hysterectomy. RESULTS A total of 28 B-Lynch sutures were performed in 3976 deliveries, all in patients that underwent cesarean section. Twenty-two of the 26 patients who avoided hysterectomy answered our questionnaire or took part in an interview. All patients recovered regular menstruation with no severe complications. Of the 19 patients who wanted another child, 12 patients (63.2%) had 14 subsequent pregnancies in a mean follow-up period of 52.1 months. The results of pregnancies were nine uncomplicated term pregnancies, all delivered by elective cesarean section, two artificial abortions and three miscarriages. A significant difference was observed in the age of patients with subsequent pregnancies and those without pregnancies (30.8 vs 34.6 years, P = 0.04). CONCLUSION B-Lynch sutures for PPH do not appear to jeopardize fecundity. An older age was a risk factor for achieving subsequent pregnancies.
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Affiliation(s)
- Mari Tadakawa
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Jamard A, Turck M, Chéret-Benoist A, Dreyfus M, Benoist G. [Risk of uterine synechiae following uterine compression sutures during postpartum haemorrhage]. ACTA ACUST UNITED AC 2014; 42:681-5. [PMID: 24996879 DOI: 10.1016/j.gyobfe.2014.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 04/28/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Uterine compression sutures are highly successful conservative surgical techniques used to treat severe postpartum haemorrhage. These methods can induce subsequent uterine synechiae. To determine this risk of synechiae after conservative uterine compression sutures, which may induce further fertility problems. PATIENTS AND METHODS We retrospectively reviewed the medical and pathological records of the patients who underwent uterine compression sutures for severe postpartum haemorrhage between January 2003 and March 2013 in a French University Hospital. The Cho's, the B-Lynch's and the Hayman's techniques have been used. The results of the hysteroscopies were detailed. RESULTS Among the 25 patients included, the B-Lynch or the Hayman's techniques have been used in 13 cases (52%). The Cho's technique has been performed alone for 5 patients (20%) and both techniques have been practiced in 7 situations (28%). In 17 cases (68%), some vascular sutures have been associated and, for 7 patients (28%), a vascular embolisation had been performed before the uterine compressive sutures. Only 19 patients underwent a diagnostic hysteroscopy and among them 13 had a normal uterine cavity (68%), 3 of them had uterine synechiae (16%) and 3 had placental retention (16%). Synechiae and retention have all been successfully removed by operative hysteroscopy. DISCUSSION AND CONCLUSION The compressive techniques can induce uterine synechiae, which may impair subsequent fertility.
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Affiliation(s)
- A Jamard
- Département d'obstétrique, de gynécologie et de médecine de la reproduction, pôle femmes-enfants, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; Université de Caen - Basse-Normandie, 14000 Caen, France
| | - M Turck
- Département d'obstétrique, de gynécologie et de médecine de la reproduction, pôle femmes-enfants, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - A Chéret-Benoist
- Département d'obstétrique, de gynécologie et de médecine de la reproduction, pôle femmes-enfants, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - M Dreyfus
- Département d'obstétrique, de gynécologie et de médecine de la reproduction, pôle femmes-enfants, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; Université de Caen - Basse-Normandie, 14000 Caen, France
| | - G Benoist
- Département d'obstétrique, de gynécologie et de médecine de la reproduction, pôle femmes-enfants, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; Université de Caen - Basse-Normandie, 14000 Caen, France.
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Begum J, Pallave P, Ghose S. B-lynch: a technique for uterine conservation or deformation? A case report with literature review. J Clin Diagn Res 2014; 8:OD01-3. [PMID: 24959485 DOI: 10.7860/jcdr/2014/8139.4284] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 01/31/2014] [Indexed: 11/24/2022]
Abstract
Postpartum haemorrhage is a leading cause of global maternal mortality and morbidity, accounting for 25-30% of all maternal deaths, and 75-90% of these casualties result from uterine atony. Uterine compressive sutures are a well established measure for control of haemorrhage following atonic postpartum haemorrhage, when medical and nonmedical interventions fail. Here, we are reporting a case of secondary infertility in a 24-year-old lady who had undergone an elective caesarean section for central placenta previa in her first pregnancy. She had massive postpartum haemorrhage, for which B-Lynch suture and vessel ligation were done. Subsequently, she failed to conceive for 4 years. This was because of severe pelvic adhesions and uterine deformation which were found intraoperatively, as a consequence of previous use of B-Lynch suture. As no definitive treatment could be offered to her, we suggested her to go for adoption.
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Affiliation(s)
- Jasmina Begum
- Assistant Professor, Department of Obstetrics and Gynaecology, Mahatama Gandhi Medical College and Research Institute , Puducherry, India
| | - P Pallave
- Associate Professor, Department of Obstetrics and Gynaecology, Mahatama Gandhi Medical College and Research Institute , Puducherry, India
| | - Seetesh Ghose
- Professor, Department of Obstetrics and Gynaecology, Mahatama Gandhi Medical College and Research Institute , Puducherry, India
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Yan JY, Zhou ZM, Xu X, Huang XY, Xu RL, Lin SH. Risk factors and surgical interventions associated with primary postpartum haemorrhage unresponsive to first-line therapies. J OBSTET GYNAECOL 2014; 34:588-92. [DOI: 10.3109/01443615.2014.920310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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18
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Later reproductive health after B-Lynch sutures: a follow-up study after 10 years' clinical use of the B-Lynch suture. Fertil Steril 2014; 101:1194-9. [DOI: 10.1016/j.fertnstert.2014.01.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 12/23/2013] [Accepted: 01/10/2014] [Indexed: 11/18/2022]
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Ibrahim MI, Raafat TA, Ellaithy MI, Aly RT. Risk of postpartum uterine synechiae following uterine compression suturing during postpartum haemorrhage. Aust N Z J Obstet Gynaecol 2012; 53:37-45. [PMID: 23163583 DOI: 10.1111/ajo.12017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 09/22/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Uterine compression suturing is considered a successful, safe, inexpensive and simple method for the conservative treatment of atonic postpartum haemorrhage (PPH). However, insufficient data are available about the potential risk of subsequent intrauterine synechiae (IUS). AIM To determine the risk of postpartum uterine synechiae in women who received isolated uterine compression suturing for the management of major uncontrolled PPH. MATERIALS & METHODS All women with major PPH from May 2005 to June 2011 were reviewed retrospectively. Diagnostic hysteroscopy was performed to assess the uterine cavity in the 27 women who successfully underwent isolated uterine compression suturing for major atonic PPH and fulfilled the study inclusion and exclusion criteria. RESULTS Among the 27 women who underwent isolated uterine compression suturing, 5 (18.5%) were found to have IUS on hysteroscopic examination. The mode of delivery for all women who developed IUS was caesarean section. Among these five women, three had mild IUS, one had moderate IUS and one had severe IUS. All adhesions were later successfully resected by hysteroscopy, except for one case with dense IUS. CONCLUSIONS Uterine compression suturing was found to be associated with a risk of postpartum uterine synechiae formation, which may subsequently affect future fertility.
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Affiliation(s)
- Moustafa I Ibrahim
- Department of Obstetrics and Gynaecology, Ain Shams University Maternity Hospital, Abbasiya Square, Cairo, Egypt
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Villar Jiménez R, Aguarón G, González-López AB, Arones MA, González de Merlo G. Técnica B-Lynch para el tratamiento de la hemorragia posparto. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2012. [DOI: 10.1016/j.gine.2010.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Alouini S, Coly S, Mégier P, Lemaire B, Mesnard L, Desroches A. Multiple square sutures for postpartum hemorrhage: results and hysteroscopic assessment. Am J Obstet Gynecol 2011; 205:335.e1-6. [PMID: 21722873 DOI: 10.1016/j.ajog.2011.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Revised: 03/12/2011] [Accepted: 05/03/2011] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the efficiency and morbidity of multiple square sutures in severe postpartum hemorrhage. STUDY DESIGN A retrospective study encompassed 30 multiple square sutures that were performed for severe postpartum hemorrhage in 26,605 deliveries in a tertiary maternity center. The main outcome measures were the ability to stop hemorrhage and the assessment of the uterine cavity by hysteroscopy at 3 months. RESULTS Multiple square sutures stopped postpartum hemorrhage in 28 of 30 cases (93%). Twenty women underwent hysteroscopy after multiple square sutures. Eight women (40%) did not have intrauterine adhesions. Nine women (45%) had thin and localized intrauterine adhesions that were removed easily by the tip of the hysteroscope; 2 women had moderate intrauterine adhesions that were resected. One patient had endometritis followed by severe intrauterine adhesions. CONCLUSION Multiple square sutures are effective and safe for the control of severe postpartum hemorrhage and for uterine conservation in most cases. Although some patients had moderate or severe adhesions, a normal uterine cavity or minimal intrauterine adhesions that were removed easily were the most frequent findings at hysteroscopy. A prospective study may be helpful to compare the safety and efficiency of square and brace sutures.
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Affiliation(s)
- Souhail Alouini
- Department of Obstetrics and Gynecology, Centre Hospitalier Régional d'Orléans, Orléans, France.
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Gezginç K, Yazici F, Koyuncu T. Results of hysterosalpingogram in women with previous B-Lynch suture. Int J Gynaecol Obstet 2011; 115:68-9. [PMID: 21767836 DOI: 10.1016/j.ijgo.2011.02.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 02/22/2011] [Accepted: 02/23/2011] [Indexed: 10/17/2022]
Affiliation(s)
- Kazım Gezginç
- Department of Obstetrics and Gynecology, Meram Medicine Faculty, Selcuk University, Akyokus, Turkey.
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Does uterine artery ligation, performed because of a severe postpartum hemorrhage, alter fertility? Fertil Steril 2011; 95:e76; author reply e77. [PMID: 21561610 DOI: 10.1016/j.fertnstert.2011.04.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Accepted: 04/26/2011] [Indexed: 11/23/2022]
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Carcopino X, Blanc J, Courbiere B, Desbriere R, Bretelle F, Boubli L, d’Ercole C. Reply of the authors. Fertil Steril 2011. [DOI: 10.1016/j.fertnstert.2011.04.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Blanc J, Courbiere B, Desbriere R, Bretelle F, Boubli L, d’Ercole C, Carcopino X. Is uterine-sparing surgical management of persistent postpartum hemorrhage truly a fertility-sparing technique? Fertil Steril 2011; 95:2503-6. [DOI: 10.1016/j.fertnstert.2011.01.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2010] [Revised: 12/07/2010] [Accepted: 01/06/2011] [Indexed: 11/26/2022]
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AMORIM-COSTA CÉLIA, MOTA RAQUEL, REBELO CLAUDIO, SILVA PEDROTIAGO. Uterine compression sutures for postpartum hemorrhage: is routine postoperative cavity evaluation needed? Acta Obstet Gynecol Scand 2011; 90:701-6. [DOI: 10.1111/j.1600-0412.2011.01137.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rathat G, Do Trinh P, Mercier G, Reyftmann L, Dechanet C, Boulot P, Giacalone PL. Synechia after uterine compression sutures. Fertil Steril 2011; 95:405-9. [DOI: 10.1016/j.fertnstert.2010.08.055] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 08/11/2010] [Accepted: 08/24/2010] [Indexed: 10/19/2022]
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