Problem: inadequate experience

Postpartum hemorrhage continues to be a global dilemma. Worldwide, an estimated 140,000 women die of postpartum hemorrhage each year. The B-Lynch brace suture is a fertility-sparing surgical option that can be used to control copious bleeding. However, its use has been hindered by limited knowledge of its intraoperative application.

Our solution

We have designed a low-cost simulator for teaching the B-Lynch brace suture technique to obstetricians ( Video Clip ). First, a model of the gravid uterus is created by stuffing a stocking with cotton wool and knotting the open end. On the top surface, we draw a line representing the hysterotomy. Reference points A and F are marked 3 cm below the hysterotomy line; reference points B and E are marked 3 cm above the hysterotomy line. These reference positions are also 4 cm from the lateral edges of the stuffed stocking.

On the bottom surface, at the level of the hysterotomy, we mark reference points C and D ; these are 5 cm from each other and 4 cm from the lateral edges of the stuffed stocking. The tied end of the stocking is then stabilized with a clipboard. A CTX needle loaded with a polyglactin 910 suture is passed through the reference points in alphabetical order. Once the suture penetrates all 6 points, an assistant compresses the stuffed stocking in an up-to-down fashion while the surgeon secures a knot.

Our simulator costs <$3. We postulate that this economical device will enable obstetricians to understand and replicate the surgical skills required for proper execution of the B-Lynch brace suture, an invaluable tool in the surgical management of postpartum hemorrhage.