Causes and management of secondary postpartum haemorrhage in a tertiary medical college hospital in Bangladesh

Abstract

Background: Globally postpartum haemorrhage remains a leading cause of maternal death. It affects only 1-2% of postnatal women. This low incidence of secondary PPH and linkage to maternal morbidity rather than mortality was the reason for the little attention among obstetricians, but it is recently gaining importance and interest with the increase morbidity and mortality related to secondary PPH.Methods: A retrospective study was conducted on the diagnosed patients of secondary PPH admitted in Enam Medical College and Hospital, Dhaka, Bangladesh, from January 2015 to December 2016. Among 33 cases of secondary PPH age of the patients, parity, mode of delivery, causes and management were noted from medical records. All data was analyzed by SPSS16.Results: Among 33 patients 14 (42.4%) were primi and 19 (57.6%) were multipara, age between 18 to 38 years, majority admitted 2nd and 3rd week after delivery. Among 33 patients 12% delivered vaginally at home and 30% vaginally at hospital and 58% undergone LUCS. We found 34% retained bits of placenta, 27% uterine wound dehiscence, 24% retained clots and 15% endometritis as causes. Less than 3 units blood needed in 22 (66.7%) patients and 11 (33.3%) needed more than 3 units. About 6 (18%) patients were treated conservatively, MVA were needed in 18 (55%) patients, repair of wound in 4 (12%) and TAH was in 5 (15%).Conclusions: Secondary PPH is increasing may result in significant maternal morbidity as well as mortality. More study needed to identify the risk factors and causes to reduce maternal mortality and morbidity.

Secondary Postpartum Haemorrhage following vaginal delivery — a 3-year survey of causes and management

“…This study identified 98 (49%) who needed an admission of more than 5 days, in agreement with a study by Kamrun Nessa et al conducted on 33 patients with a history of secondary PPH; 24 (73%) needed an admission of more than 5 days. This finding relates to surgical management and hysterectomies due to delays in seeking care rather than medical treatment, and this aggressive surgical intervention required longer hospitalizations [18]. We found a wide range of treatment modalities for the management of secondary PPH, ranging from medical to surgical, and about 33 (16.5%) patients responded to conservative management and 47 patients needed vaginal exploration after delivery.…”

Study on maternal and perinatal outcome in eclampsia in a tertiary care hospital

“…In a study by Nessa et al caesarean section were common mode of delivery being 68.57% whereas delivered vaginally were only 37.14% cases. 12 Raji et al reported normal labour was seen in 31.51%, instrumental delivery 3.42%, spontaneous expulsion 2.74%, LSCS 61.65%, hysterotomy 0.68%. 13 Ghimire et al reported nearly 70% women underwent caesarean section.…”

Hysteroscopy to identify retained placental tissue and excision in secondary post-partum haemorrhage

“…They have used MVA for retained products of conception and retained clots. 14 The traditional causes of postpartum hemorrhage, which typically are retained placental fragments, are less likely to arise after C. section, because the delivery of the placenta is directly observed. 15,16 Eight patients (0.15%) who had delivered by caesarean section, developed secondary PPH, while six (0.26%) of patients who delivered vaginally developed secondary PPH.…”