Delayed Postpartum Hemorrhage: A Retrospective Analysis

Severe Secondary Postpartum Hemorrhage: A Historical Cohort

“…The incidence of severe secondary PPH in our study was 23 per 10,000 deliveries (0.23%), consistent with the lowest incidence rate, reported by Boyd et al . Other studies have reported rates ranging from 0.4 to 1.4 percent .…”

“…In many patients, techniques to evacuate the uterus were necessary. Authors have reported rates of surgical uterine evacuation ranging from 34.8 to 91.7 percent ; these rates are higher than ours. It would be reasonable as a first‐line treatment to use medical treatment initially, reserving surgical management for patients when the first treatment fails .…”

“…Depending on the study, the frequency of secondary PPH appears to vary from 0.2 to 3.0 percent of deliveries . This frequency is difficult to estimate because only severe secondary PPH results in readmission.…”

“…Moreover, the cause of the secondary hemorrhage often remains unknown, in the absence of routine uterine surgical evacuation, which is not always essential to the woman's medical care. It is, however, the histopathologic examination of these aspiration products that most often produces the diagnosis, especially that of subinvolution (also sometimes referred to as noninvolution or delayed involution) of the placental bed . Subinvolution is an abnormal involution of the placental bed, characterized by widely distended and partly hyalinized maternal vessels.…”

Risk Factors for Severe Secondary Postpartum Hemorrhages: A Historical Cohort Study

“…Few publications have examined secondary PPH (bleeding that occurs between 24 hours and 42 days after birth) . The incidence of these secondary PPHs is low, ranging from 0.2 to 3 percent . This frequency is probably underestimated, however, because studies generally include only severe PPH requiring hospitalization.…”