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Subsequent pregnancy outcome after B-lynch suture placement
Alison D Cowan1, Emily S Miller, William A Grobman
1Department of Maternal-Fetal Medicine, Northwestern University, Chicago, Illinois.
Obstetrics and Gynecology
|August 28, 2014
Summary
The B-Lynch suture, used for postpartum hemorrhage, does not increase the risk of adverse pregnancy outcomes like abnormal placentation in future pregnancies. This finding offers reassurance for women who have undergone this procedure.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Reproductive Health
Background:
- Postpartum hemorrhage (PPH) is a significant cause of maternal morbidity.
- The B-Lynch suture is a surgical technique employed to manage severe PPH when conservative measures fail.
- Concerns exist regarding the potential impact of uterine compression sutures on subsequent pregnancies.
Purpose of the Study:
- To investigate the association between the use of the B-Lynch suture during a previous PPH event and adverse pregnancy outcomes in subsequent pregnancies.
- To evaluate risks related to abnormal placentation following B-Lynch suture placement.
Main Methods:
- A cohort study compared women with a history of PPH and B-Lynch suture placement to those with PPH but no B-Lynch suture.
- The primary outcome was a composite of placentation abnormalities: placenta previa, placenta accreta, preeclampsia, preterm birth, or small-for-gestational-age neonate.
- Logistic regression analysis controlled for confounding factors.
Main Results:
- Sixty-three of 252 patients had a prior B-Lynch suture.
- Women with a prior B-Lynch suture had higher blood loss and transfusion rates during the index PPH pregnancy.
- There was no significant difference in the composite adverse outcome between groups (14.3% vs. 13.8%, P=.92).
- Adjusted analysis showed no association between B-Lynch suture exposure and adverse pregnancy outcomes (aOR 0.88, 95% CI 0.34-2.28).
Conclusions:
- Placement of the B-Lynch suture is not associated with an increased risk of future adverse pregnancy outcomes.
- Specifically, risks related to abnormal placentation in subsequent pregnancies are not elevated after B-Lynch suture use.
- This study provides evidence to alleviate concerns about the long-term reproductive impact of the B-Lynch suture.
