A woman with placenta previa totalis undergoes cesarean at 37 weeks. After delivery of the placenta the uterus fails to contract. Oxytocin infusion, ergometrine, and carboprost have been administered. Bleeding continues at 1.2 L. What is the next surgical step before hysterectomy?
- A Internal iliac artery ligation
- B Uterine balloon tamponade
- C B-Lynch compression suture ✓
- D Selective uterine artery embolization
Correct answer: C. B-Lynch compression suture
Explanation
The B-Lynch brace suture is a compression suture applied to the uterus to mechanically reduce blood flow and stimulate uterine contraction; it is indicated when medical uterotonic therapy fails and before proceeding to hysterectomy. Balloon tamponade is an option but is typically used before surgical compression sutures or when uterus is closed. Internal iliac ligation and UAE are alternatives but require more specialized access; B-Lynch is the most practical immediate step at laparotomy.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.