Written by Dr.M.D.Mazumdar, MD
A secondary postpartum haemorrhage is defined as abnormal or excessive bleeding from the birth canal between 24 hours and 12 weeks of the postnatal period.
Primary postpartum haemorrhage (PPH) is more common and more dangerous ( Read more abou Primary PPH here . Secondary postpartum hemorrhage occurrs in less than 1% of all births.
While Primary PPH is an acute condition requiring immediate management, the bleeding in secondary PPH is usually not so severe. The patient may complain of spotting on and off for days after her delivery with an occasional gush of fresh blood.
Sometimes, this bleeding may be confused with postpartum lochia, which is a normal discharge after childbirth. It is only when the bleeding continues for days or when it increases in severity or when other symptoms like fever and pain occur that a woman may consult a doctor for help.
Women with pre-existing bleeding disorders such as haemophilia and women taking anticoagulant medicines are at increased risk of PPH. These are somewhat uncommon causes of secondary PPH and will not be described in this page.
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Investigations of secondary PPH should include high and
low vaginal swabs,blood cultures if fever is present ,full blood count and C-reactive protein. A pelvic ultrasound may help to identify the presence of retained products of conception, although the appearance of the immediate postpartum uterus may not be very reliable.
If products of pregnancy are present, they should be removed under antibiotic cover. There is a great risk of uterine perforation in these cases and the evacuation of the uerus should be carried out only by very competent hands.
It is generally accepted that secondary PPH is often associated with infection and conventional treatment involves antibiotics and medicines to control the bleeding.
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