Recurrent Secondary Postpartum Haemorrhage After Lower Segment Caesarean Section

Keane, B.

doi:10.1097/00006254-197408000-00008

Cited by 2 publications

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“…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. 11 In this study, four of the five cases of secondary PPH were following caesarean delivery.…”

Section: Discussionmentioning

confidence: 99%

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

Devabhaktuni¹,

Allani²

2020

Int J Reprod Contracept Obstet Gynecol

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Background: Most cases of secondary postpartum haemorrhage (PPH) are due to retained placental products (RPP). This study had a crop of five cases of secondary PPH, referral cases, during a period of six months during 2006. Four cases were following a caesarean delivery and in one, sub mucous and intra mural, uterine fibroids, caused retained placental tissue by distortion of the uterine cavity. Objectives of this study were to evaluate the feasibility of hysteroscopy to identify the retained placental products in cases of secondary postpartum haemorrhage. Verification of complete removal of RPP by reinsertion of hysteroscope, after removal of RPP by using a sponge holder, or curette.Methods: Trans vaginal ultrasonography (TVS) identified echogenic retained products of conception in all cases. Surgical profile investigations were done as per protocol. Transfusion of blood products was needed in some. Bettocchi 5 mm continuous flow hysteroscope (Karl Storz) was used. Storz endomat hysteroflator was used for irrigation and aspiration.Results: Hysteroscopic guided excision of the placental tissue was one-time treatment in four of study cases, and one needed a second hysteroscopic excision. Secondary PPH occurred at varying periods after the caesarean delivery, one week in one, two weeks in one case, three weeks in two cases and one woman was admitted with retained placenta, primary PPH continuing to secondary PPH. Hysteroscopy done during the puerperal period, in cases of secondary PPH, had certain challenges to cope with.Conclusions: Hysteroscopic guided excision of the retained placental tissue was successful in all the five cases with secondary postpartum haemorrhage. Hysteroscopy is an excellent procedure in cases of secondary PPH. We request guidelines committees to consider including hysteroscopic guided removal of retained placental products, in the algorithm of management of secondary PPH.

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Section: Discussionmentioning

confidence: 99%

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

Devabhaktuni¹,

Allani²

2020

Int J Reprod Contracept Obstet Gynecol

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“…However, after the review of the literature, there is one specific situation that is related to secondary postpartum hemorrhage and published in MEDLINE. The search in this register (June 2011) under keywords “secondary or delay or unusual cause of postpartum hemorrhage” showed 18 papers dealing with secondary postpartum hemorrhage where 9 papers [ 7 , 10 , 21 - 27 ] reported cases of secondary PPH after cesarean section with two major conclusions: placental site VSI or uterine artery pseudoaneurysm. To explain how cesarean section enhances the higher occurrence of VSI is difficult.…”

Section: Discussionmentioning

confidence: 99%

Recurrent secondary postpartum hemorrhages due to placental site vessel subinvolution and local uterine tissue coagulopathy

Žúbor

Kajo

Dokus

et al. 2014

BMC Pregnancy Childbirth

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BackgroundPostpartum hemorrhage (PPH) represents a serious problem for women and obstetricians. Because of its association with hemorrhagic shock and predisposition to disseminated coagulopathy, it is a leading cause of maternal deaths worldwide. Furthermore, the jeopardy of PPH is rising with the secondary form of PPH occurring between 24 hours and 6 weeks postpartum, when women are already discharged home. The causes of this pathology are severe inflammation (endometritis), inherited coagulation disorders, consumptive coagulopathy, and retained products of conceptions. Others are of rare occurrence, such as vessel subinvolution (VSI) of the placental implantation site, uterine artery pseudoaneurysm, or trauma.Case presentationWe present a rare form of recurrent secondary postpartum hemorrhage in a woman after uncomplicated cesarean delivery, with review of the literature linked to the management of this situation originating in the rare local VSI in the placental implantation site, defective decidual homeostasis, and coagulopathy confined to the uterus.ConclusionThe placental site VSI is one of the rare causes of secondary PPH, and this situation is frequently underdiagnosed by clinicians. The histological confirmation of dilated “clustered”-shaped myometrial arteries partially occluded by thrombi of variable “age” together with the presence of endovascular extravillous trophoblasts confirms the diagnosis.

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Recurrent Secondary Postpartum Haemorrhage After Lower Segment Caesarean Section

Cited by 2 publications

References 0 publications

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

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

Recurrent secondary postpartum hemorrhages due to placental site vessel subinvolution and local uterine tissue coagulopathy

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