Uterine Compression Sutures and Balloon Tamponade
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Direct answer
Uterine compression sutures and balloon tamponade are mechanical measures that control postpartum haemorrhage from atony when uterotonic drugs have failed. The B-Lynch brace suture compresses the uterine walls together from outside, while the Bakri intrauterine balloon applies pressure from inside the cavity. Both are used for refractory atony, usually after oxytocin and other uterotonics have been given.
What you must remember
- B-Lynch suture: A brace suture passed across the uterus from front to back and tied to compress both walls, placed through a laparotomy.
- Bakri balloon: A silicone intrauterine balloon inserted through the cervix and filled, commonly with 300 to 500 mL of saline.
- Balloon duration: Left in place for no more than about 24 hours, with drainage monitored, then deflated and removed once bleeding has settled.
- Balloon complications: Expulsion, infection, and uterine perforation or necrosis if the balloon is overfilled.
- Suture complications: Uterine necrosis and ureteric injury when placed carelessly, so the ureters and uterine blood supply are protected during placement.
- Escalation rule: Hysterectomy is the final step when bleeding continues despite uterotonics, compression measures and balloon tamponade.
Choosing between a suture and a balloon
Both devices aim to compress the bleeding uterus, but they differ in how they are placed and how the woman is monitored afterwards. The comparison below captures the points most often tested.
| Feature | B-Lynch suture | Bakri balloon |
|---|---|---|
| Mechanism | Brace suture compresses the uterine walls | Filled balloon exerts internal pressure |
| Placement | Through a laparotomy | Transcervical, without laparotomy |
| Usual setting | Operating theatre under anaesthesia | Labour ward or theatre |
| Duration | Suture left in situ | Removed within about 24 hours |
| Main risks | Uterine necrosis, ureteric injury | Expulsion, infection, perforation |
A balloon is quicker to insert and avoids a laparotomy, so it is often tried first where the device is available. The brace suture is preferred when the balloon is unavailable or has failed, and both need careful follow-up for infection and ongoing bleeding.
Whichever device is used, the team records the fill volume, insertion time and removal time, because these details guide follow-up and any later decision.
Where the exam tries to catch you
Questions usually test the placement route, the duration and the complications rather than the technique itself.
- Trap: Choosing a B-Lynch suture as the first mechanical step in every case. Correct: The balloon is simpler and avoids laparotomy where available, while the B-Lynch suture is reserved for refractory atony.
- Trap: Leaving the Bakri balloon in place for several days. Correct: The balloon is removed within about 24 hours, once bleeding has settled, to reduce infection risk.
- Trap: Using compression devices for uterine rupture. Correct: Rupture needs surgical repair or hysterectomy, because compression cannot seal a tear in the uterine wall.
Frequently asked questions
What does the B-Lynch suture do in postpartum haemorrhage?
The B-Lynch suture is a brace suture that compresses the uterus from front to back, reducing the space available for bleeding in atony. It is usually placed through a laparotomy. It is commonly used when uterotonics and simpler measures have not controlled the bleeding.
How long is a Bakri balloon left in situ?
A Bakri balloon is commonly left in place for no more than about 24 hours. It is then deflated and removed once bleeding has settled. Drainage is monitored throughout, and prolonged retention raises the risk of infection.
What volume of saline is used to fill the Bakri balloon?
The Bakri balloon is commonly filled with about 300 to 500 mL of saline. Overfilling can cause uterine necrosis, so the volume is kept within the recommended range for the device.
When is hysterectomy considered after compression measures fail?
Hysterectomy is considered when bleeding continues despite uterotonics, compression sutures and balloon tamponade. Arterial ligation or embolisation may be tried first in some centres. Hysterectomy remains the definitive surgical step for uncontrolled atony.