secondary postpartum haemorrhage

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Secondary post-partum haemorrhage is the presence of any excess, frank bleeding 24 hours after delivery. It most usually occurs 8 to 10 days after this time. It occurs after approximately 1% of all deliveries.

Causes include:

  • retained products of conception
  • displacement of blood clot
  • infection
  • abnormal involution of the placental site
  • choriocarcinoma

An offensive discharge pv implies an infectious aetiology. This is managed by 'blind' systemic, broad-spectrum antibiotics while waiting for culture results from a high vaginal swab.

Conservative management may be appropriate if the vaginal loss is slight and there is no sign of infection.

If there is heavy vaginal bleeding, a tender uterus with an open os, or the suggestion of retained products on ultrasound examination then this requires obstetric exploration.

Last reviewed 01/2021

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