Introduction
In this clinical article, we look at how important it is to correctly place and complete a b-suture to lessen blood loss in patients.
Case Example
In a recent case, the patient had a traumatic C-section, leading to massive obstetric haemorrhage and the tearing of both ovaries. After multiple attempts at trying to lessen the blood loss, the patient underwent a b-lynch suture which was incorrectly placed. This led to the ovary becoming necrotic and needing to be removed.
Independent Recommendations to Improve Healthcare Standards and Patient Safety
A B-Lynch Suture is a form of ‘uterine compression’ suture used in Obstetrics. B-Lynch Sutures are not the most common form of care when faced with a haemorrhaging patient, and in fact, are often only used when a uterus is post-delivery and the uterine atony has not resolved following the use of uterotonics.
B-Lynch Laminate Guide
When attempting to suture the uterus, it is important to have to hand the b-lynch suture laminate guide in the operating theatre, to double check that the positioning and look of the suture is correct. Whilst the Royal College of Obstetricians and Gynaecologists state that a laminate must be available to review, even if not needed, clinicians should remember if they have not completed this procedure in some time, to review this.
Placement
Clinicians should remember to review the suture once placed, to make sure that it is not cutting off the blood supply to any ovaries as this can cause the organ to become necrotic. Whilst these sutures are used in high-risk situations and are necessary to prevent further bleeding, the importance of ovary preservation should not be overlooked and should be checked before the patient is taken out of theatre to recovery.
Conclusions
TMLEP’S independent clinical recommendation is that when treating patients with b-sutures, make sure that a laminate guide is available for review, another Consultant with experience in these sutures can be called upon if needed and ultimately, that there are no organs caught inadvertently in the suture. These recommendations can assist is preserving the organs of the patients in addition to their fertility.
By raising awareness of the above issues, TMLEP aims to assist in developing awareness of difficulties in dealing with wound packing and the advice to limit inadvertent retainment, thereby improving clinical care and reducing litigation risk.