Subsequent pregnancy following B-Lynch suture, bilateral ligation of uterine arteries, utero-ovarian arteries and internal iliac arteries due to uterine atony – A case report

IntroductionPostpartum hemorrhage is currently the leading cause of death of birthing mothers in Poland. Uterine atony remains one of its major causes. Treatment of uterine retraction failure consists of application of B-Lynch suture, O-Leary uterine artery ligation, utero-ovarian arteries ligation and internal iliac arteries ligation.AimThe aim of this work was to present a case of a patient, in whom conservative surgical treatment for uterine atony allowed preserving fertility and subsequent pregnancy.Case studyThe authors report a case of a patient, in whom after cesarean delivery a postpartum hemorrhage was diagnosed during the fourth stage of labor due to uterine atony. After unsuccessful pharmacological attempts and performing dilation and curettage procedure, a decision about surgical treatment was made. During relaparotomy B-Lynch suture was applied and bilateral ligation of uterine arteries, its ovarian branches and internal iliac arteries was performed. After 19 months the patient was diagnosed with early pregnancy. During subsequent weeks uncomplicated course of pregnancy with normal fetal development was observed.Results and discussionImplementation of conservative surgical treatment in the course of postpartum hemorrhage allowed preserving fertility and subsequent pregnancy. The authors have analyzed the available literature on the conservative surgical treatment in postpartum hemorrhage.ConclusionsIn a group of selected patients with postpartum hemorrhage a risk of conservative surgical treatment, that gives the chance to preserve fertility, can be taken. This is of particular importance in women with further procreative plans.