Challenges and diagnosis in therapy of secondary amenorrhea in caesarean section patient with postpartum hemorrhage B-lynch sutures: a case report

Abstract

Introduction and importance: FIGO (International Federation of Gynecology and Obstetrics) and WHO (World Health Organization) report the incidence of postpartum hemorrhage (PPH) reaches 1-10% and contributes to an increase in postpartum maternal mortality with uterine atony as the most common cause. B-Lynch method is a suturing technique to overcome PPH. Athough this method has proven useful as an emergency life-saving measure, the post-procedure complications are still able to occur. Presentation of case: The patient was not menstruating for 14 months after giving birth through caesarean section with B-Lynch due to PPH. Before pregnancy, she had regular menstruation cycle and normal menstrual duration. Her general and gynecological status were normal. Ultrasound showed the impression of uterine hypoplasia and endometrium that were difficult to assess while both ovaries were normal. Diagnostic hysteroscopy showed a severe degree of Asherman’s syndrome. The results of FSH, LH and estradiol were normal. Discussion: B-lynch suture is performed as a method to stop PPH in uterine atony. Secondary amenorrhea occurs as a complication of B-lynch. Compression action of B-lynch can cause progressive myometrium necrosis resulting in synechiae and blockade of uterine blood flow. This will interfere with the development of the uterus. Intrauterine adhesions and amenorrhea with normal levels of FSH, LH, and estradiol support the diagnosis of Asherman’s syndrome. Conclusion: Our case shows that the B-Lynch procedure, which is the worldwide recommended method for treating postpartum hemorrhage due to its high success rate, can cause complications of Asherman’s syndrome and cause secondary amenorrhea.