Secondary PPH is rare. Accurate diagnosis is based most often on histopathologic findings.

(Birth. 2015;42(2):149–155) As postpartum hemorrhage occurring within the first 24 hours of delivery is a common cause of mortality and has been the subject of many studies, the same is not true for secondary postpartum hemorrhage, a condition in which there is significant bleeding from the genital tract anytime between 24 hours after delivery and the 42nd postpartum day. The authors of this study attempted to address this deficit in the literature by determining the incidence rate of severe secondary postpartum hemorrhage. They also sought to describe and assess the various causes of this condition.

This cohort study confirms that immediate PPH is a risk factor for severe secondary PPH and reports for the first time an association between secondary PPH and advanced maternal age. It is likely that risk factors for immediate PPH are also risk factors for severe secondary PPH and thus that immediate PPH may be an intermediate factor between its own known risk factors and secondary PPH.

(Birth. 2015;42(3):235–241) Immediate postpartum hemorrhage is a common and dangerous complication for which risk factors have been established. However, there is a distinct lack of research regarding secondary postpartum hemorrhage, with only 2 studies reporting on possible risk factors. These studies found a variety of risk factors, including immediate postpartum hemorrhage, hemorrhage during pregnancy, manual removal of the placenta, a history of secondary postpartum hemorrhage, hospitalization during the third trimester, maternal smoking, and a prolonged or incomplete third stage of labor. The authors of this study sought to determine what factors might indicate an increased risk for severe secondary postpartum hemorrhage with the primary goal being to determine the association with immediate postpartum hemorrhage.

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