Secondary Post‐partum Haemorrhage

Dewhurst, C. J.

doi:10.1111/j.1471-0528.1966.tb05120.x

Cited by 55 publications

(23 citation statements)

References 4 publications

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“…Secondary postpartum haemorrhage was initially defined as that occurring during the first 10 hours after birth 3 , but is now universally accepted as commencing more than 24 hours following birth and during the following six weeks 4,5 . The rate reported in this study of 0.8% or 1:123 women delivered vaginally is broadly similar to rates reported in the past 40 years of 0.5% 6 , 1.0% 7 , and 1.3% 8 . Despite a dramatic increase in hospital confinements over that time and almost universal use of an oxytocic during, or immediately following, the birth, there has been no obvious improvement in the incidence of secondary postpartum haemorrhage.…”

Section: Discussionsupporting

confidence: 89%

“…As has been reported by others 6,7 , women presenting with secondary postpartum haemorrhage usually do so during the second postpartum week, with the next largest proportion during the third week. By this time, most women have been discharged from hospital after vaginal and abdominal delivery 9 .…”

Section: Discussionsupporting

confidence: 68%

“…In the present study only 2% were still in hospital at this time. This compares with the 94% still in hospital reported by Dewhurst 7 for the period covering 1955‐1964. However, the risks to women would generally be considered greater once they have been discharged from hospital.…”

Section: Discussionsupporting

confidence: 52%

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Secondary postpartum haemorrhage: incidence, morbidity and current management

Hoveyda¹,

MacKenzie

2001

BJOG

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Objective To determine the incidence, risk factors, presentation, treatment and morbidity associated with secondary postpartum haemorrhage. Design Analysis of 132 consecutive women presenting with secondary postpartum haemorrhage occurring over a three-year period. Setting The maternity unit in a district general teaching hospital serving an annual delivery rate of around 6500 women. Main outcome measures Factors associated with the cause of the haemorrhage and the resulting morbidity.Results Most women presented during the second week after delivery. A history of primary postpartum haemorrhage (OR 9.3; 95% CI 6.2-14.0) and manual removal of placenta (OR 3.5; 95% CI 1.6-7.5) were the only signi®cant risk factors identi®ed. There was a high associated morbidity, with 84% requiring hospital admission, 63% surgical evacuation, 17% blood transfusion, with three women suffering a uterine perforation, one managed by hysterectomy. In women undergoing evacuation only, 37% had retained placental tissue con®rmed after surgery; pre-operative ultrasound examination did not provide a better discrimination over clinical assessment for this ®nding. Conclusions Secondary postpartum haemorrhage occurs in just under 1% of women, is associated with primary postpartum haemorrhage and retained placenta, and may result in signi®cant maternal morbidity. This problem deserves more attention than it has received in recent years.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 68%

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Secondary postpartum haemorrhage: incidence, morbidity and current management

Hoveyda¹,

MacKenzie

2001

BJOG

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“…The incidence is between 0.5 and 1.5% [1]. The most common causes are retained products of conception and/or infection [2]. Standard treatment is with antibiotics and/or evacuation of retained products of conception (ERPC).…”

Section: Introductionmentioning

confidence: 99%

Postpartum transcervical endometrial resection under laparoscopic control for retained degenerated products of conception

et al. 2005

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We describe a case of postpartum haemorrhage due to retained products of conception that failed to resolve after two attempts of evacuation of retained products of conception. A subsequent histology and MRI scan confirmed retained products of conception despite repeated attempts at treatment. We introduce transcervical endometrial resection as an efficient method of removing degenerated retained products of conception refractory to standard treatment.

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confidence: 99%

Two Unusual Cases of Secondary Postpartum Haemorrhage

MacVicar

Graham

1973

Obstetrical & Gynecological Survey

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Secondary postpartum haemorrhage is most often due to retained parts of placenta or to infection (Dewhurst, 1966). It seldom occurs after caesarean section, since the placenta is usually completely delivered. Similarly, rupture of a caesarean section scar presenting as a case of secondary postpartum haemorrhage must be very unusual. The following two cases are therefore worth recording. Case 1The patient, aged 29 years, was admitted under our care on her twelfth postpartum day with moderately severe vaginal bleeding. Her first pregnancy and labour had been five years previously. Thereafter she had had three abortions. Consequently when her fifth pregnancy was confirmed a Shirodkar suture of tantalum wire was inserted. At 24 weeks she was admitted to hospital because of intermittent vaginal bleeding. At 34 weeks regular uterine contractions began and the cord was found to be prolapsed down the cervical canal, despite the Shirodkar suture. A male child weighing 2,000 g was delivered by lower segment caesarean section. The operation showed no apparent abnormality, the puerperium was uneventful, and the patient went home after nine days.Our hospital flying squad was called three days later because the patient had had vaginal bleeding for 24 hours, which had become worse. The uterus was the size of a 12 weeks' pregnancy, but the cervix barely admitted a finger owing to the presence of the Shirodkar suture. There was little pelvic tenderness. Vaginal bleeding continued after admission despite a slow infusion of oxytocin (syntocinon), and an ultrasonogram showed a uterus of almost 18 weeks' size full of blood clot with an area at the level of the lower segment which was thought could represent a retrovesical haematoma. The Shirodkar suture was removed under premedication, and obviously much blood and clot had been dammed back in the uterine cavity. Despite further intravenous oxytocin bleeding increased. Examination under anaesthesia revealed a dehiscence of the entire caesarean section scar with a large haematoma cavity behind the bladder. The uterus, now of about 14 weeks' pregnancy size, was lying backwards. At laparotomy immediately afterwards 250 ml of altered blood was found in the peritoneal cavity. When the clot was removed from a large retrovesical haematoma the gaping lower segment of the uterus was defined and brisk bleeding was seen coming from the angles of the lower segment wound. The tissues were very friable and infected, and the old lower segment scar was gaping widely with slough on the wound edges. Bleeding was eventually arrested by subtotal hysterectomy and oversewing the cervical stump. At the completion of the operation the patient had received 14 units of blood and her general condition was good.Convalescence was uneventful and she went home after 17 days. Histological examination of the uterus showed extensive infection but no malignancy. Six weeks later she was well. The cervix was healthy and mobile and there was no evidence of residual inflammation in the wound or pelvis. Case 2The patient, ...

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Secondary Post‐partum Haemorrhage

Cited by 55 publications

References 4 publications

Secondary postpartum haemorrhage: incidence, morbidity and current management

Secondary postpartum haemorrhage: incidence, morbidity and current management

Postpartum transcervical endometrial resection under laparoscopic control for retained degenerated products of conception

Two Unusual Cases of Secondary Postpartum Haemorrhage

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