الفهرس 
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Abstract
Our Study aimed to evaluate the effect of B Lynch suture as a prophylactic procedure for prevention of PPH during cesarean delivery in high risk cases attending Beni-Suef University Hospital and Al-Fayoum Public Hospital, includes 150 pregnant women who done CS with risk factors for atonic PPH included past history of atonic PPH, over distended uterus (polyhydramnios, multiple pregnancy and fetal macrosomia), the patients will be divided into 2 groups the 1st group75patients underwent a prophylactic B Lynch suture and the 2nd group 75patients didn’t undergo a prophylactic B Lynch suture and all patients in both groups were inject 10IU oxytocin immediately following delivery of fetus no significant statistical difference between the studied groups regarding demographic characteristics .In B Lynch and control groups Mean ±SD of age was 27.6±3.6 and 27.1±3.5 respectively , of BMI was 26.8±1.3 and 26.7±1.6,parity was 1.8±1.3 and 1.9±1.1 respectively ,while GA was 38.5±1.2 and 38.4±1.1 respectively.
Then the uterus was assessed for early signs of PPH including towels number used and weak uterine tone, B Lynch group don’t take time than usual time of CS, simple, easy to perform.
No significant difference between the studied groups regarding preoperative hemoglobin in B Lynch group Mean ± SD 11.2±0.5 gm/dl and in control group Mean ±SD 11.3±0.5 while postoperative Hb in B Lynch group Mean ±SD 9.5±0.7gm/dl and in control group Mean ±SD 9.2±0.8 gm/dl . Postoperative Hb was significantly higher among B Lynch group than among control group .
Hb reduction was significantly lower among B Lynch group than among control group . In B Lynch and control groups Mean ±SD of Hb reduction was 1.7±0.6 and 2.1±0.6 respectively.
The maternal complications e.g uterotonic usage, paralytic ileus and blood transfusion were less frequent among B Lynch group.
In B Lynch group Mean±SD of postnatal hospital stay was 50.9±2.6 hours while in control group Mean±SD 53.1±3.1 hours.
According to our study B Lynch suture was significant procedure in prevention of atonic PPH in high risk cases
PPH is an obstetric emergency that can occur after vaginal delivery or CS. the causes of PPH might include uterine atony, placental adhesion, retention of placenta, retention of blood clots, genital lesions or trauma, in addition to disorders of coagulation the incidence of PPH has been recorded to be 4 - 6% of all pregnancies.
Our series of cases treated with the B Lynch procedure showed that it is an efficient procedure in controlling PPH it has the advantage of being easily applied and quickly and should be taught to all trainees and registrars in obstetrics.
sever degree of uterine compression might result in uterine anatomic destruction, whereas simple compression technique is surgically easy, with lifesaving potential, provides relative safety, less time consuming and can be managed by trained doctors after some experience.
The B Lynch suture prevents hemorrhage and transfusion related morbidities in mild & moderate intractable PPH and the uterus can be saved in severe PPH by this easy and cost effective approach the B Lynch suture is very effective in low resource setting hospitals and doesn’t need specific material, as the same suture used for suturing the uterine hysterotomy incision during CS could be used as well if other fast absorbable suture materials aren’t readily available.
It is an effective procedure for surgical management of atonic uterus particularly in young patients where fertility issues are concern and has more advantage as less time of application, little hemorrhage and less skill requirement
B Lynch suture is an effective addition to surgical treatment of PPH as it is an easy technique, lifesaving and can reserve the uterus hysterectomy is associated with morbidity in a young females along with loss of fertility that can be prevented by applying of B Lynch suture.
On the basis of data derived from the our experience with B Lynch it can be concluded that B Lynch suture technique has proved invaluable as 1st line surgical resort in controlling massive PPH due to atonic uterus as an alternative to hysterectomy.