title: Subsequent pregnancy outcome after B-lynch suture placement.
abstract: OBJECTIVE
  To evaluate whether use of the B-Lynch suture is associated with subsequent adverse pregnancy outcomes.
  
  
  METHODS
  This is a cohort study of women who experienced postpartum hemorrhage between January 2000 and June 2010 and had a subsequent pregnancy at a single university hospital. Women who had postpartum hemorrhage and B-Lynch suture were compared with those complicated by postpartum hemorrhage but no B-Lynch suture placement. The primary outcome was a composite adverse outcome related to placentation abnormalities and included placenta previa, placenta accreta, preeclampsia, preterm birth, or a small-for-gestational-age neonate. The study was powered to detect a twofold difference in the frequency of the composite outcome.
  
  
  RESULTS
  Two hundred fifty-two patients met inclusion criteria, 63 of whom had a prior B-Lynch suture. Women with a prior B-Lynch had a higher mean estimated blood loss (1,800 mL compared with 1,200 mL, P<.001) and were more likely to have received a blood transfusion (29.2% compared with 13.3%, P=.01) in the index pregnancy. The composite outcome was not different between the groups (14.3% compared with 13.8%, P=.92). A logistic regression controlling for potential confounding factors did not show any association between exposure to a B-Lynch suture and adverse pregnancy outcome in a subsequent pregnancy (adjusted odds ratio 0.88, 95% confidence interval 0.34-2.28.
  
  
  CONCLUSIONS
  Placement of a B-Lynch suture is not associated with an increased risk of future adverse pregnancy outcomes related to abnormal placentation.
  
  
  METHODS
  II.
authors.affiliation: Department of Maternal-Fetal Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Alison D
authors.initials: AD
authors.lastname: Cowan
authors.forename: Emily S
authors.initials: ES
authors.lastname: Miller
authors.forename: William A
authors.initials: WA
authors.lastname: Grobman
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005317:Fetal Growth Retardation / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D010922:Placenta Diseases / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D006473:Postpartum Hemorrhage / Q000601:surgery*; D011225:Pre-Eclampsia / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D047928:Premature Birth / Q000453:epidemiology / Q000209:etiology; D017584:Reproductive History; D012189:Retrospective Studies; D013536:Suture Techniques / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology