Secondary Postpartum Haemorrhage: Causes and Management In A Tertiary Care Hospital

Abstract

Objective: To find out the frequency of secondary postpartum haemorrhage (pph) as well as its causes and management in women presenting in a tertiary care hospital Methods: It was a descriptive case series study conducted from 1st January 2016 to 31st December 2016 at the Department of Gynaecology and Obstetrics, Dr. Ruth K.M.Pfau Civil Hospital, Karachi. All the patients presenting with secondary postpartum haemorrhage in the specified time period were included in the study. The patient's age, parity, booking status, mode of delivery, place of delivery, cause of secondary postpartum haemorrhage and management done was noted on a predesigned proforma. Results: The average age of the women was 30.62 ± 4.37 years. Postpartum haemorrhage was ob- served in 130 patients, out of these 27 patients had secondary postpartum haemorrhage with a fre- quency of 20.67%. Majority of the women with secondary pph were multiparous 17 (62.96%) with 21 (77.77%) being delivered vaginally compared to 6 (22.22%) who had caesarean section. Most of the women 16 (59.25%) presented with secondary pph around 10-14 days post-delivery. Retained placen- tal pieces was identified as the commonest cause in 19 (70.37%) women, antibiotics was given to all the patients, evacuation done in 19 (70.37%) cases, 2 (7.40%) women had obstetrical hysterectomy and 1 (3.70%) woman had repair of uterus while 5 (18.51%) cases were managed conservatively. No maternal death was recorded. Conclusion: Secondary postpartum haemorrhage though less common but is found to be associated with significant maternal morbidity which require timely diagnosis and management so as to prevent life threatening complications.

Keywords

• Primary postpartum haemorrhage, secondary postpartum haemorrhage, Retained prod- ucts of conception.