A G4P3 woman develops massive postpartum hemorrhage unresponsive to oxytocin, ergometrine, and carboprost. Examination of the genital tract reveals no lacerations. The uterus is atonic. Which surgical procedure is performed FIRST before proceeding to hysterectomy?

• A Internal iliac artery ligation
• B Uterine artery embolization
• C B-Lynch brace suture ✓
• D Stepwise devascularization (O'Leary suture)

Explanation

The B-Lynch brace suture is a compression suture applied to the uterus that mechanically compresses the uterine body to control atonic PPH; it is performed before proceeding to more radical procedures. It is a uterine-conserving option used as a step-up approach. Internal iliac artery ligation reduces pulse pressure by approximately 85% bilaterally but has a technically demanding learning curve. When conservative surgical measures fail, peripartum hysterectomy is the definitive procedure.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.