Question: In a woman with postpartum haemorrhage, does the combined use of a uterine compression suture and intrauterine balloon lead to uterine necrosis and other complications?
Please note: the search for this response was carried out over 1 year ago. Eligible users may request an update of the evidence by submitting a new Clinical Query here.
Answer: No systematic reviews were found which investigated the combined use of uterine compression sutures and intrauterine balloons. However, one series of five cases (1) (Evidence level IIb) found that, when the use of a B-Lynch suture alone failed to stop uterine bleeding, the addition of a Bakri balloon as well was successful. In this series of five, no patients developed uterine necrosis although one patient developed endomyometritis (following an antepartum diagnosis of chorioamnionitis) and a second developed postpartum oliguria.
A further two case reports (2, 3) (Evidence level IIb) describe using balloon catheters in conjunction with a B-Lynch suture in cases of severe postpartum haemorrhage. In both cases, the patient made a full recovery
References:
- Nelson WL. O'Brien JM. The uterine sandwich for persistent uterine atony: combining the B-Lynch compression suture and an intrauterine Bakri balloon. American Journal of Obstetrics & Gynecology. 196(5):e9-10, 2007 May. Available here.
- Price, N. Whitelaw, N. B-Lynch, C. Application of the B-Lynch brace suture with associated intrauterine balloon catheter for massive haemorrhage due to placenta accreta following a second-trimester miscarriage. Journal of Obstetrics & Gynaecology. 26(3):267-8, 2006 Apr.
- Danso, D. Reginald, P. Combined B-lynch suture with intrauterine balloon catheter triumphs over massive postpartum haemorrhage. BJOG: An International Journal of Obstetrics & Gynaecology. 109(8):963, 2002 Aug.
Search date: March 2009
Classification of evidence levels
Ia Evidence obtained from meta-analysis of randomised controlled trials.
Ib Evidence obtained from at least one randomised controlled trial.
IIa Evidence obtained from at least one well-designed controlled study without randomisation.
IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.
III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.
IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.
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