The Management of Secondary Postpartum Hemorrhage

Secondary postpartum hemorrhage (PPH) is defined as excessive vaginal bleeding from 24 h after delivery up to 6 weeks postpartum1. Unlike the definition of primary PPH, there is no clear or standard definition for quantity of the blood loss associated with secondary PPH, and clinical expressions of this definition vary from ‘increased lochia’ to massive bleeding. The diagnosis is therefore all too often subjective, which may account for the numerous variations in reported incidence. Overall, the reported incidence of secondary PPH in the developed world varies from 0.47% to 1.44%2,3. The etiology of secondary PPH is diverse, and management is dependent on identifying the cause and tailoring treatment appropriately (Table 1). In contrast to primary PPH, the published work on the management of secondary PPH is limited4. However, with declining maternal mortality rates in many parts of the world, interest in and attention to maternal morbidity and the important topic of management of secondary PPH is increasing. The majority of cases are associated with minor morbidities but may still require re-admission to hospital, use of antibiotics and surgical intervention. In more extreme cases, major morbidity may require hysterectomy, arterial ligation or radiological intervention5. Despite the use of all available interventions, maternal death may still result from massive secondary PPH.