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Introduction PPH is one of the leading cause of maternal mortality worldwide and uterine atony is accountable for 75-90% of PPH. Historically, B-Lynch suture was first used in 1989 but only described in 1997 and has been used as mechanical compression onto severely atonic uterus to control bleeding in view of preserving fertility. However, multiple case reports have cited numerous long-term complications. Clinical description 31-year-old G2P1 at 17-weeks of gestation, presented to ED following conscious collapse. She was pale, tachycardia and hypotensive. Abdominal examination identified a midline scar, distended and peritonitic. It was then identified that she has had a B-Lynch suture following a PPH post ventouse delivery. A FAST scan showed a large hemoperitoneum and live 'intrauterine' pregnancy. She promptly had explorative laparotomy that revealed a ruptured antero-fundal uterus with the placenta extruding approximately 6- 7 cm in size. Initial attempt to repair the ruptured site was performed. Unfortunately, she had a hysterectomy due to ongoing bleeding despite uterotonics. EBL was 5 litres, in which she received 18u PRBC, 5u cryoprecipitate and 3u FFP. Her postoperative course was uneventful and was discharged home on Day 4. She and her family had very extensive counselling which included surrogacy for future fertility. Discussion Uterine compression sutures have been theoretically taught as an established surgical method in management of severe postpartum haemorrhage despite the lack of hands on procedural opportunity. This led to the questioning of the correct technique in B-Lynch procedure following the variation of complications reported. At present, there are insufficient data on ongoing follow-up with regards to long-term outcomes. These data are essential seeing that the procedure is reserved for severe postpartum haemorrhage in view of conserving anatomical fertility, but there are emerging case reports published citing complications following the p

Introduction PPH is one of the leading cause of maternal mortality worldwide and uterine atony is accountable for 75-90% of PPH. Historically, B-Lynch suture was first used in 1989 but only described in 1997 and has been used as mechanical compression onto severely atonic uterus to control bleeding in view of preserving fertility. However, multiple case reports have cited numerous long-term complications. Clinical description 31-year-old G2P1 at 17-weeks of gestation, presented to ED following conscious collapse. She was pale, tachycardia and hypotensive. Abdominal examination identified a midline scar, distended and peritonitic. It was then identified that she has had a B-Lynch suture following a PPH post ventouse delivery. A FAST scan showed a large hemoperitoneum and live 'intrauterine' pregnancy. She promptly had explorative laparotomy that revealed a ruptured antero-fundal uterus with the placenta extruding approximately 6- 7 cm in size. Initial attempt to repair the ruptured site was performed. Unfortunately, she had a hysterectomy due to ongoing bleeding despite uterotonics. EBL was 5 litres, in which she received 18u PRBC, 5u cryoprecipitate and 3u FFP. Her postoperative course was uneventful and was discharged home on Day 4. She and her family had very extensive counselling which included surrogacy for future fertility. Discussion Uterine compression sutures have been theoretically taught as an established surgical method in management of severe postpartum haemorrhage despite the lack of hands on procedural opportunity. This led to the questioning of the correct technique in B-Lynch procedure following the variation of complications reported. At present, there are insufficient data on ongoing follow-up with regards to long-term outcomes. These data are essential seeing that the procedure is reserved for severe postpartum haemorrhage in view of conserving anatomical fertility, but there are emerging case reports published citing complications following the p