COMPARISON OF B-LYNCH SUTURE VS SYNTOCINON INFUSION FOR POSTPARTUM HEMORRHAGE PROPHYLAXIS IN CARDIAC PATIENTS UNDERGOING CESAREAN SECTION-A RANDOMIZED CLINICAL TRIAL

Abstract

Objective: To compare the efficacy and safety of syntocinon infusion and B-Lynch suture application for
postpartum hemorrhage prophylaxis in cardiac patients.
Study design: Randomized clinical trial.
Place and duration of Study: This study was conducted at obstetrics and gynecology ward of Armed Forces
Institute of Cardiology/National Institute of Heart Disease (AFIC-NIHD) from Jan 2015 Dec 2015.
Methodology: All the eligible patients undergoing cesarean section at AFIC-NIHD were included. Primary
outcome measure was primary postpartum hemorrhage requiring additional measures. Secondary outcome
was difference in hemoglobin level and hemodynamic status between two groups. Safety was assessed by
development of cardiac complications like pulmonary edema, arrhythmias and ischemia.
Results: A total of 45 patients were randomized to either low dose syntocinon group or B-lynch group. Mean
age of our study population was 27.16 ± 4.57. Parity between two groups was in-significant (p=0.46), most of
the patients were of parity2 i.e. 16 (35.6%). Of all the patients 32 (71.7%) had acquired heart disease,9(20%)
congenital and 4(8.9%) rhythm disorders. Post partum hemorrhage in group A was 5 (71.4%) and group B
was 2(28.5%),P=1.000.Blood pressure and heart rate changes with intervention were statistically significant
between group A and B. Cardiac complications between two groups were arrhythmias(P=0.670),ischemia
(p=1.000), pulmonary edema (p=0.157) and cardiac arrest (p=1.000).
Conclusion: Cardiac patients are unique, considering their hemodynamic status and limitation in treatment
options. This combined with a life threatening complication like postpartum haemorrhage can be a
catastrophe......