Secondary Post-Partum Haemorrhage Flashcards
What is secondary postpartum haemorrhage?
Excessive vaginal bleeding in the period from 24 hours - 12 weeks postpartum
What is the overall incidence of postpartum haemorrhage in the developed world?
0.47-1.44%
What are the causes of secondary postpartum haemorrhage?
- Endometritis
- Retained placental fragments or tissue
- Abnormal involution of placental site
- Trophoblastic disease
What is meant by abnormal involution of the placental site?
Inadequate closure and sloughing of spiral arteries at the placental attachment site
Is trophoblastic disease common?
No, it is very rare
What is the main symptom of secondary PPH?
Excessive vaginal bleeding
How does the severity of secondary PPH compare to primary?
It is usually not as severe as primary
How might the patient describe the vaginal bleeding in secondary PPH?
May complain of spotting on-and-off for days after delivery, with occasional gush or fresh blood
What % of cases of secondary PPH will present with massive haemorrhage?
10%
What do the additional clinical features of secondary PPH depend on?
The underlying cause
What symptoms might be present with endometritis?
- Fever/rigors
- Lower abdominal pain
- Foul smelling lochia
What is lochia?
The normal discharge from the uterus following childbirth
What may be found on abdominal examination in secondary PPH?
- Lower abdominal tenderness
- Uterus may still be high
What is lower abdominal tenderness a sign of?
Endometritis
What is the uterus being high a sign of?
Retained placenta
Why is speculum examination important in secondary PPH?
To assess amount of bleeding
What should be done during speculum examination in secondary PPH?
High vaginal swab
How should secondary PPH be managed if the patient is haemodynamically unstable or bleeding heavily?
Call for help and follow resuscitation algorithm
Should you establish a cause before resuscitation is commenced in secondary PPH where the patient is haemodynamically unstable or bleeding heavily?
No
What laboratory tests should be done in secondary PPH?
- FBC
- Urea and electrolytes
- C-reactive protein
- Coagulation profile
- Group and save
- Blood cultures (if pyrexial)
How might a pelvic ultrasound be helpful in secondary PPH?
Can assist in diagnosis of retained placental tissue
What is the problem with diagnosing retained placental tissue on ultrasound in secondary PPH?
The over-diagnosis of retained placental tissue on ultrasound can lea to unnecessary surgical intervention
What is a pelvic ultrasound good regarding retained placental tissue?
It has a good negative predictive value, and so is helpful in excluding the diagnosis
What is the mainstay of treatment for secondary PPH?
- Antibiotics
- Uterotonics
