Secondary postpartum haemorrhage: incidence, morbidity and current management

Abstract

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.

Pseudo aneurysm of uterine artery and cesarean scar dehiscence causing secondary post-partum haemorrhage managed by uterine artery embolisation: a case report

“…Overall incidence of secondary PPH in developed world varies from 0.47% to 1.44 %. 3,4 Secondary PPH causes more morbidity than mortality. However severe secondary PPH may sometimes become fatal.…”

Building our global family – achieving treatment for all

“…PPH can be prevented or its severity can be moderated by educating women and their providers [8]. While delayed or secondary PPH is rare, occurring after <1% of deliveries [10,11], it has been reported in 20-25% of women with VWD [12,13], 2-11% of haemophilia carriers [14,15] and 24% of women with factor XI deficiency [14]. Carriers are another significant and often neglected member of the global bleeding disorder family.…”

Hysteroscopic resection of retained placental tissue: a feasibility study

“…Half of all secondary postpartum haemorrhages are caused by retained placental tissue (RPT) [3]. Various drug therapies and surgical therapies to control the bleeding, to clean out the uterus, and to prevent or treat infection are used as treatment.…”

“…Approximately 1-2% of all singleton deliveries are complicated by retained placental tissue (RPT) [1][2][3]. Half of all secondary postpartum haemorrhages are caused by retained placental tissue (RPT) [3].…”