Secondary postpartum haemorrhage: incidence, morbidity and current management

Hoveyda, Fatemeh; MacKenzie, I.Z.

doi:10.1016/s0306-5456(01)00230-3

Cited by 61 publications

(77 citation statements)

References 11 publications

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“…Hoveyda et al reported in his review regarding secondary postpartum hemorrhage that the frequency of perforation of the uterus was 3% and hysterectomy about 1%. 54 Similar results are reported from an audit of 200 cases concerning puerperal curettage. 70 They showed that 8.5% of patients experienced major morbidity and 7% required a repeat procedure with further morbidity.…”

Section: Retained Placental Tissuesupporting

confidence: 73%

Postpartum Ultrasound

Mulic‐Lutvica¹

2012

Donald School Journal of Ultrasound in Obstetrics and Gynecology

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This article describes uterine and uterine cavity changes throughout the normal and pathological puerperium, as revealed by various ultrasound modalities. A gray scale ultrasound, color and pulsed Doppler ultrasound and 3D ultrasound were used. It is based on results of several prospective longitudinal studies, which were designed so that every woman was examined at six occasions during the puerperium, namely on postpartum days 1, 3, 7, 14, 28 and 56. The first four examinations were performed transabdominally and the last two transvaginally. The same design was used in all studies. The involution process of the uterus was assessed by measuring the anteroposterior diameter of the uterus and uterine cavity. Morphological findings were recorded. The influence on the involution process of parity, breastfeeding, maternal smoking and infant's birth weight were also evaluated. Besides conventional ultrasound, Doppler technology was used to study hemodynamic events occurring during the normal puerperium. The pulsatility (PI) and resistance (RI) indices in the uterine arteries were measured, and the presence or absence of early diastolic notches was recorded. A hypervascular area in myometrium was assessed by color and power Doppler. Normal involution process was also described by means of 3D ultrasound. The volume of the uterus and uterine cavity after normal vaginal delivery were measured using virtual organ computer-aided analysis (VOCAL) using six adjacent planes and a 30° rotation method. Reference values from uncomplicated puerperium were used when pathological conditions were studied.Results from these studies, which shed light on normal and pathological changes during the puerperium, are summarized in this chapter.

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Section: Retained Placental Tissuesupporting

confidence: 73%

Postpartum Ultrasound

Mulic‐Lutvica¹

2012

Donald School Journal of Ultrasound in Obstetrics and Gynecology

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“…Statistical analysis of different causes of secondary post partum hemorrhage portrayed that the most common cause of secondary post partum hemorrhage was retained uterine products same as found in past studies [2,6]. Cervical and vaginal tear also emerged as one of the cause of delayed or secondary post partum hemorrhage in contrast to the past studies [2,6,13].…”

Section: Discussionmentioning

confidence: 50%

“…Cervical and vaginal tear also emerged as one of the cause of delayed or secondary post partum hemorrhage in contrast to the past studies [2,6,13]. …”

Section: Discussionmentioning

confidence: 88%

“…Its incidence is 5% of all deliveries [5]. Secondary is defined as excessive vaginal blood loss or heavy lochial discharge occurring at least 24 hours after the end of the third stage of labor [6]. …”

Section: Resultsmentioning

confidence: 99%

“…It is also indicated that massive PPH leads to complication like hypovolumic shock, disseminated intravascular coagulation ,hepatic dysfunction, acute respiratory distress syndrome and renal failure [3,5,6]. In order to prevent these complications, an organized stepwise protocol should be followed and active management of third stage of labor should be offered to all women.…”

Section: Resultsmentioning

confidence: 99%

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“Post partum hemorrhage: causes and management”

et al. 2013

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BackgroundPost partum hemorrhage is defined as blood loss of 500 ml or above. It is the most common cause of pre-mature mortality of women world wide. Our objective was to evaluate the most common etiology and method of management of Post partum Hemorrhage in a tertiary care hospital of Karachi.FindingsIt was a cross sectional study conducted at Liaquat National Hospital Karachi, during the period of July 2011 to May 2012. Review include mode of delivery, possible cause of postpartum hemorrhage, supportive, medical and surgical interventions. All the women admitted with post partum hemorrhage or develop PPH in hospital after delivery were included in our study. Bleeding disorder and use of anticoagulants were set as exclusion criteria. Diagnosis was made on the basis of blood loss assessment which was made via subjective and objective evaluation.During the targeted months, out of total 1493 deliveries (26/1493 = 1.741%) 26 cases of post partum hemorrhage were reported with a mean age of 26.153 ± 7.37. No deaths were reported and all cases were referred and unbooked cases. All Patients were conscious, tachycardiac and hypotensive. Most of the women were suffering from hemorrhage during or after the birth of their 1st child. Primary post partum hemorrhage emerge as the most common type of post partum hemorrhage and uterine atony was detected as the most common cause of primary post partum hemorrhage. Retained products of conception was the most common cause of secondary post partum hemorrhage and hysterectomy was found to be the most frequent method of management of post partum hemorrhage.ConclusionThis study highlights the existing variable practices for the management of postpartum hemorrhage. Hemorrhage associated morbidity and mortality can be prevented by critical judgment, early referral and resuscitation by attendants. Introduction of an evidence-based management model can potentially reduce the practice variability and improve the quality of care.

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