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Secondary Postpartum Hemorrhage
Matthew R Carroll1, Mark A Turrentine1
1Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
O&G Open
|August 1, 2026
Summary
Secondary postpartum hemorrhage, occurring weeks after delivery, is often caused by retained products of conception. Ultrasound is key for diagnosis, but standardized criteria and prospective studies are needed for better management.
Area of Science:
- Obstetrics and Gynecology
- Maternal Health
Background:
- Secondary postpartum hemorrhage (PPH) is excessive bleeding 24 hours to 6-12 weeks postpartum.
- It is an uncommon but significant cause of maternal morbidity.
- Retained products of conception is the most frequent etiology.
Purpose of the Study:
- To review the current understanding of secondary PPH.
- To highlight diagnostic challenges and management variations.
- To identify the need for standardized diagnostic criteria and prospective research.
Main Methods:
- Review of existing literature on secondary PPH.
- Analysis of risk factors, diagnostic findings, and management strategies.
- Evaluation of diagnostic accuracy of ultrasound findings.
Main Results:
- Retained products of conception is the most common cause of secondary PPH.
- Primary PPH and manual placental extraction are associated risk factors.
- Ultrasound showing an echogenic intrauterine mass is predictive, but criteria lack standardization.
Conclusions:
- Current evidence is limited by retrospective study designs.
- Standardized diagnostic approaches are needed.
- Prospective studies are essential to guide optimal management strategies for secondary PPH.
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