Secondary postpartum haemorrhage: incidence, morbidity and current management

Abstract

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.