open access

Vol 91, No 10 (2020)
Research paper
Published online: 2020-10-02
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Secondary Postpartum Haemorrhage following vaginal delivery — a 3-year survey of causes and management

Dina Akeel Salman1, Reshed Zeki Obeid2, Zainab Abdul Ameer Jaafar1
DOI: 10.5603/GP.a2020.0095
·
Pubmed: 33184829
·
Ginekol Pol 2020;91(10):607-612.
Affiliations
  1. Department of Obstetrics and Gynecology, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq
  2. Department of Obstetrics and Gynecology, College of Medicine, Al-Anbar University, Al-Anbar, Iraq

open access

Vol 91, No 10 (2020)
ORIGINAL PAPERS Obstetrics
Published online: 2020-10-02

Abstract

Objectives: Secondary postpartum haemorrhage (PPH) is a serious complication of childbirth and a life-threatening condition
that may lead to infertility amongst women during the reproductive age groups.
The objective of this study is to highlight the underlying causes of secondary PPH and outcomes for patients who delivered
vaginally, with the aim of reducing maternal mortality and morbidity.
Material and methods: This is a prospective cohort study conducted in the Department of Obstetrics and Gynaecology
at AL-Yarmouk Teaching Hospital, Baghdad, Iraq. The study was conducted over a 3-year period from December 2015 to
December 2018. Women who delivered vaginally with a gestational age of at least 24 weeks, with no previous caesarean or
uterine scars, who were admitted to the hospital complaining of bleeding from their genital tracts after 24 hours of delivery,
but prior to 6 weeks from delivery, were enrolled in the study. Patients received resuscitative measures and medical treatment
and were observed regarding their response to medical treatment and whether they required surgical intervention.
Types of management were also evaluated, and histopathological reviews were gathered and recorded for those who
needed retained pieces of product evacuated or hysterectomies.
Results: Two hundred cases were analysed; the incidence of severe secondary postpartum haemorrhage was 60 per
10,000 deliveries. Endometritis was the leading cause (64% of patients), followed by retained placental pieces (13.5%);
emergency hysterectomy was performed in 34.5% of patients. This study is novel because it is the first to shed light on
secondary postpartum haemorrhage in unscarred uteri in Iraq.
Conclusions: Endometritis was the most common cause of secondary postpartum haemorrhage, and emergency hysterectomy
was the most common strategy of treatment.

Abstract

Objectives: Secondary postpartum haemorrhage (PPH) is a serious complication of childbirth and a life-threatening condition
that may lead to infertility amongst women during the reproductive age groups.
The objective of this study is to highlight the underlying causes of secondary PPH and outcomes for patients who delivered
vaginally, with the aim of reducing maternal mortality and morbidity.
Material and methods: This is a prospective cohort study conducted in the Department of Obstetrics and Gynaecology
at AL-Yarmouk Teaching Hospital, Baghdad, Iraq. The study was conducted over a 3-year period from December 2015 to
December 2018. Women who delivered vaginally with a gestational age of at least 24 weeks, with no previous caesarean or
uterine scars, who were admitted to the hospital complaining of bleeding from their genital tracts after 24 hours of delivery,
but prior to 6 weeks from delivery, were enrolled in the study. Patients received resuscitative measures and medical treatment
and were observed regarding their response to medical treatment and whether they required surgical intervention.
Types of management were also evaluated, and histopathological reviews were gathered and recorded for those who
needed retained pieces of product evacuated or hysterectomies.
Results: Two hundred cases were analysed; the incidence of severe secondary postpartum haemorrhage was 60 per
10,000 deliveries. Endometritis was the leading cause (64% of patients), followed by retained placental pieces (13.5%);
emergency hysterectomy was performed in 34.5% of patients. This study is novel because it is the first to shed light on
secondary postpartum haemorrhage in unscarred uteri in Iraq.
Conclusions: Endometritis was the most common cause of secondary postpartum haemorrhage, and emergency hysterectomy
was the most common strategy of treatment.

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Keywords

secondary postpartum haemorrhage; caesarean section; hysterectomy; endometritis

About this article
Title

Secondary Postpartum Haemorrhage following vaginal delivery — a 3-year survey of causes and management

Journal

Ginekologia Polska

Issue

Vol 91, No 10 (2020)

Article type

Research paper

Pages

607-612

Published online

2020-10-02

DOI

10.5603/GP.a2020.0095

Pubmed

33184829

Bibliographic record

Ginekol Pol 2020;91(10):607-612.

Keywords

secondary postpartum haemorrhage
caesarean section
hysterectomy
endometritis

Authors

Dina Akeel Salman
Reshed Zeki Obeid
Zainab Abdul Ameer Jaafar

References (22)
  1. Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014; 2(6): e323–e333.
  2. Baldvinsdóttir T, Blomberg M, Lilliecreutz C. Improved clinical management but not patient outcome in women with postpartum haemorrhage-An observational study of practical obstetric team training. PLoS One. 2018; 13(9): e0203806.
  3. Iraha Y, Okada M, Toguchi M, et al. Multimodality imaging in secondary postpartum or postabortion hemorrhage: retained products of conception and related conditions. Jpn J Radiol. 2018; 36(1): 12–22.
  4. Dossou M, Debost-Legrand A, Déchelotte P, et al. Severe secondary postpartum hemorrhage: a historical cohort. Birth. 2015; 42(2): 149–155.
  5. Oyelese Y, Ananth CV. Postpartum hemorrhage: epidemiology, risk factors, and causes. Clin Obstet Gynecol. 2010; 53(1): 147–156.
  6. MH vL, O E. Transvaginal Ultrasound-guided Thrombin Injection for the Treatment of Secondary Postpartum Hemorrhage Caused by a Pseudoaneurysm of the Uterine Artery. Journal of Rare Disorders: Diagnosis & Therapy. 2016; 2(4).
  7. Guerado E, Medina A, Mata MI, et al. Protocols for massive blood transfusion: when and why, and potential complications. Eur J Trauma Emerg Surg. 2016; 42(3): 283–295.
  8. Bul SB, Susan Z, Jahan R, et al. Secondary Postpartum Hemorrhage Following Cesarean Section. Journal of Shaheed Suhrawardy Medical College. 2018; 9(1): 23–25.
  9. Bogaerts A, Witters I, Van den Bergh BRH, et al. Obesity in pregnancy: altered onset and progression of labour. Midwifery. 2013; 29(12): 1303–1313.
  10. Mulic-Lutvica A, Eurenius K, Axelsson O. Uterine artery Doppler ultrasound in postpartum women with retained placental tissue. Acta Obstet Gynecol Scand. 2009; 88(6): 724–728.
  11. Debost-Legrand A, Rivière O, Dossou M, et al. Risk Factors for Severe Secondary Postpartum Hemorrhages: A Historical Cohort Study. Birth. 2015; 42(3): 235–241.
  12. Ijaiya MA, Aboyeji AP, Abubakar D. Analysis of 348 consecutive cases of primary postpartum haemorrhage at a tertiary hospital in Nigeria. J Obstet Gynaecol. 2003; 23(4): 374–377.
  13. Ajenifuja KO, Adepiti CA, Ogunniyi SO. Post partum haemorrhage in a teaching hospital in Nigeria: a 5-year experience. Afr Health Sci. 2010; 10(1).
  14. Khalil RY. Association between Anemia during Pregnancy and post partum hemorrhage and perinatal outcome among women with vaginal Births in slemani maternity teaching hospital. ZANCO J Pure Appl Sci. 2018; 30(4): 65–72.
  15. Jabbar S, Perveen S, Kumari R. Secondary Postpartum Haemorrhage: Causes and Management In A Tertiary Care Hospital. Ann Abbasi Shaheed Hosp Karachi Med Dent Coll. 2019; 24(1).
  16. Nigeen W, Farooq M, Afzal A, et al. Secondary postpartum haemorrhage in a tertiary care hospital of North India: a retrospective analysis. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2017; 6(2): 532.
  17. Krishna Hm, Chava M, Jasmine N, et al. Patients with postpartum hemorrhage admitted in intensive care unit: Patient condition, interventions, and outcome. J Anaesthesiol Clin Pharmacol. 2011; 27(2): 192–194.
  18. Nessa K, Bari S, Khan S, et al. Causes and management of secondary postpartum haemorrhage in a tertiary medical college hospital in Bangladesh. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2017; 6(7): 2694.
  19. Sheikh L, Najmi N, Khalid U, et al. Evaluation of compliance and outcomes of a management protocol for massive postpartum hemorrhage at a tertiary care hospital in Pakistan. BMC Pregnancy Childbirth. 2011; 11: 28.
  20. Kittur S, D. S. Emergency peripartum hysterectomy- a study in tertiary care centre and medical college in Hubli, North Karnataka, India. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2016: 1097–1101.
  21. Kasap B, Akbaba E, Öner G, et al. Evaluation of Patients with Postpartum Hemorrhage Patients in a University-Affiliated Tertiary Care Hospital. Haseki Tıp Bülteni. 2016; 54(1): 13–18.
  22. Tihana G, Maja B, Kosjenka D, et al. Secondary postpartum hemorrhage : a review of the literature. 2017; 1(3): 138–40.

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