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Secondary postpartum haemorrhage: incidence, morbidity and current management
1Barrett Maternity Hospital, Northampton, UK.
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 significant risk factors identified. 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 confirmed after surgery; pre-operative ultrasound examination did not provide a better discrimination over clinical assessment for this finding.
Conclusions:
Secondary postpartum haemorrhage occurs in just under 1% of women, is associated with primary postpartum haemorrhage and retained placenta, and may result in significant maternal morbidity. This problem deserves more attention than it has received in recent years.