In the management of massive postpartum haemorrhage (PPH) unresponsive to first-line uterotonics (oxytocin, ergometrine, carboprost), the next surgical option before proceeding to hysterectomy is B-Lynch suture. The B-Lynch suture compresses the uterus by:
- A Ligating the uterine arteries bilaterally at their origin from the internal iliac artery
- B Tamponading the uterine cavity by packing with a balloon inflated to 200 mL
- C Applying a longitudinal vertical compression suture that bows the uterus like a brace, reducing myometrial blood flow ✓
- D Applying horizontal mattress sutures across the lower uterine segment to close sinusoids
Correct answer: C. Applying a longitudinal vertical compression suture that bows the uterus like a brace, reducing myometrial blood flow
Explanation
The B-Lynch suture (1997, Christopher B-Lynch) is a compression suture applied after opening the lower uterine segment. A No. 2 chromic catgut suture is looped from the lower uterine incision over the fundus and under the posterior wall bilaterally, creating a longitudinal brace-like compression that mechanically reduces uterine volume and blood flow, promoting haemostasis. It is distinct from uterine artery ligation (stepwise devascularisation) and from intrauterine balloon tamponade. The compression mimics manual bimanual compression of the uterus.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.