Important uterine sutures against atony
4. B lynch uterine sutures :
– A large Mayo needle with #2 chromic catgut is used to enter & exit the uterine cavity at 1 & 2.
– The suture is looped over the fundus & then reenters the uterine cavity posteriorly at 3, which is directly below 2. The suture should be pulled very tight at this point.
– It then enters the posterior wall of the uterine cavity at 4, is looped back over the fundus, and anchored by entering the anterior lateral lower uterine segment at 5 & crossing through the uterine cavity to exit at 6.
– The free ends at 1 & 6 are tied down securely to compress the uterus.
– The technique has been used alone & in combination with balloon tamponade. This combination has been called the “uterine sandwich.”
5. Bhal technique:
– The only modification to the B-Lynch suture.
-This entail 2 sutures instead of 1, with the knots tied in the anterior-inferior margin of the lower uterine segment, without any difference in the compression effects compared to the original B-Lynch suture.
Discussion about this post