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Secondary postpartum haemorrhage: incidence, morbidity and current management
Article first published online: 22 DEC 2003
DOI: 10.1111/j.1471-0528.2001.00230.x
Issue
1471-0528/asset/cover.gif?v=1&s=b4e1d96c46e18c61210d584b63c13ee375cf562b "BJOG: An International Journal of Obstetrics & Gynaecology")
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 108, Issue 9, pages 927–930, September 2001
Additional Information
How to Cite
Hoveyda, F. and MacKenzie, I.Z. (2001), Secondary postpartum haemorrhage: incidence, morbidity and current management. BJOG: An International Journal of Obstetrics & Gynaecology, 108: 927–930. doi: 10.1111/j.1471-0528.2001.00230.x
Publication History
- Issue published online: 22 DEC 2003
- Article first published online: 22 DEC 2003
- Accepted 23 May 2001
- Abstract
- Article
- References
- Cited By
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 outcomemeasures 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.