In management of massive postpartum hemorrhage unresponsive to uterotonics and bimanual compression, the B-Lynch compression suture is applied to the uterus. What is its anatomical mechanism of action?

• A Bilateral uterine artery ligation reducing 80–90% of uterine blood flow
• B Vertical brace sutures compressing the uterine body, approximating anterior and posterior walls to reduce sinusoidal blood flow ✓
• C Horizontal mattress sutures at the lower uterine segment occluding the arcuate vessels
• D Peritoneal flap closure trapping hematoma and applying tamponade effect

Explanation

The B-Lynch suture (described by Christopher B-Lynch in 1997) uses a chromic catgut or Vicryl suture placed as a vertical brace around the uterus. When tied, it compresses the uterine body by approximating the anterior and posterior uterine walls, collapsing the venous sinusoids and capillary beds within the myometrium, thereby reducing blood flow mechanically. It is distinct from uterine artery ligation (O'Leary sutures) which interrupts arterial supply. The B-Lynch suture is successful in approximately 90% of cases of atonic PPH when correctly placed.

Reference: Williams Obstetrics, 26th ed.

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