ESE San Rafael de Rondón, Rondón (Colombia)..
Hospital Universitario San Rafael de Tunja, Tunja (Colombia)..
Rev Colomb Obstet Ginecol. 2023 Jun 30;74(2):153-162. doi: 10.18597/rcog.3989.
To describe the use of the B-Lynch suture in a case of postpartum hemorrhage of a woman with bicornuate uterus, and to carry out a review of the literature on PPH control strategies in patients with müllerian anomalies, maternal outcomes in terms of hemorrhage control, as well as early and late complications.
Case report of a patient with bicornuate uterus who presented to a regional referral hospital with postpartum hemorrhage following a cesarean section, which was successfully controlled using the B-Lynch suture. A search was conducted in the PubMed, Embase, Medline, Google Scholar and LILACS databases. The MeSh terms used were: “Uterine Atony,” “Postpartum Hemorrhage,” “Immediate Postpartum Hemorrhage,” “Bicornuate Uterus,” “Müllerian Anomalies,” “Müllerian Duct Abnormalities”. Case reports and case series of patients with müllerian malformations and PPH not responding to initial pharmacological management in whom conservative surgical procedures were used to control bleeding were included. A narrative analysis of the findings was carried out based on study characteristics, techniques used and complications.
Five studies were selected, 4 case reports and 1 case series which included 12 women with uterine malformations who developed PPH and in whom surgical management (uterine compression sutures) or devices (intrauterine balloon) were used for hemorrhage control. Bleeding was successfully controlled in 11 cases, with hysterectomy required only in one case (8.3 %). No long-term complications were reported.
The literature on PPH management in women with müllerian uterine malformations is limited to case reports in which either compression sutures or medical devices such as intrauterine balloons were used. The B-Lynch-type compression suture appears to be a good option for controlling PPH in these women in order to preserve fertility, with a low rate of complications. Further documentation of these types of cases is needed in order to build the evidence regarding the usefulness of this technique for controlling postpartum uterine bleeding in this population.
描述一例双角子宫产后出血患者使用 B-Lynch 缝合术的情况，并对文献中关于畸形子宫产妇产后出血控制策略、控制出血方面的母体结局，以及早期和晚期并发症的相关文献进行回顾。
报告一例双角子宫患者，该患者在剖宫产术后出现产后出血，在区域转诊医院成功使用 B-Lynch 缝合术控制出血。在 PubMed、Embase、Medline、Google Scholar 和 LILACS 数据库中进行了检索。使用的 MeSH 术语是：“子宫收缩乏力”、“产后出血”、“即时产后出血”、“双角子宫”、“Müllerian 异常”、“Müllerian 管异常”。纳入了病例报告和病例系列研究，这些研究对象为对初始药物治疗无反应的 Müllerian 畸形和 PPH 患者，采用保守性手术来控制出血。根据研究特征、所使用的技术和并发症，对研究结果进行了叙述性分析。
选择了 5 项研究，其中包括 4 项病例报告和 1 项病例系列研究，共纳入 12 例因子宫畸形而发生 PPH 的女性，这些患者采用手术管理（子宫压迫缝合术）或器械（宫内球囊）来控制出血。11 例出血得到成功控制，仅 1 例（8.3%）需要行子宫切除术。未报告长期并发症。
关于 Müllerian 子宫畸形产妇 PPH 管理的文献仅限于病例报告，其中使用了压迫缝合术或宫内球囊等医疗设备。B-Lynch 型压迫缝合术似乎是一种很好的选择，可以控制这些女性的 PPH，从而保留生育能力，并发症发生率低。需要进一步记录这些类型的病例，以提供关于该技术在控制该人群产后子宫出血方面的有效性的证据。
