Secondary postpartum haemorrhage is any abnormal or excessive bleeding from the birth canal occurring between 24 hours and 12 weeks postnatally. In developed countries, 2% of postnatal women are admitted to hospital with this condition, half of them undergoing uterine surgical evacuation. Data are not available from developing countries.
To evaluate the relative effectiveness and safety of the treatments used for secondary postpartum haemorrhage.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2008), the reference lists of trial reports and reviews and sought further sources from the first named authors of the papers identified.
All randomised or quasi-randomised comparisons between drug therapies, surgical therapies and placebo or no treatment for the management of secondary postpartum haemorrhage occurring between 24 hours and three months following a pregnancy of at least 24 weeks' gestation.
Data collection and analysis
Two authors scrutinised reports of possibly eligible studies. The third author acted as an advisor or arbitrator.
Of the 47 papers (36 studies) identified, none met the inclusion criteria.
No information is available from randomised controlled trials to inform the management of women with secondary postpartum haemorrhage. This topic may have received little attention because it is perceived as being associated with maternal morbidity rather than mortality in developed countries; it is only recently that the extent and importance of postnatal maternal morbidity has been recognised. A well-designed randomised controlled trial comparing the various therapies for women with secondary postpartum haemorrhage against each other and against placebo or no treatment groups is needed.