Severe Secondary Postpartum Hemorrhage: A Historical Cohort

Dossou, Mathieu; Debost‐Legrand, Anne; Déchelotte, Pierre; Lémery, D.; Vendittelli, Françoise

doi:10.1097/01.aoa.0000482617.10292.a3

Cited by 8 publications

(17 citation statements)

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“…The retained products of conception (RPOC) refers to any intrauterine tissue of trophoblastic origin that is present or that develops after delivery. It was reported that 33.3% of sPPH is due to such RPOC [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…An arteriovenous malformation (AVM) refers to a vascular anomaly where arteries and veins are directly connected through a complex void of the usual intermediate capillary bed. AVM is reported to account for only 3.3% of sPPH [ 2 ], making sPPH due to AVM very rare, compared to RPOC. Recently, AVM has sometimes been described as ‘enhanced myometrial vascularity’ (EMV), which refers to a focus of abnormally increased vascularity in the post-partum myometrium.…”

Section: Introductionmentioning

confidence: 99%

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The RPOC long axis is a simple indicator for predicting the need of invasive strategies for secondary postpartum hemorrhage in either post-abortion or post-partum women: a retrospective case control study

Kobayashi

Nakagawa

Kawanishi

et al. 2021

BMC Pregnancy Childbirth

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Background The retained products of conception (RPOC) and related conditions (RPOC-ARC) are the main cause of secondary postpartum hemorrhage (sPPH), but there is no clear consensus for their management. The purpose of this study was to characterize those RPOC-ARC that require invasive treatment and those that could be managed more conservatively. Methods We retrospectively analyzed 96 cases of RPOC-ARC that occurred after miscarriage, abortion, or delivery at a gestational age between 12 and 42 completed weeks, that were managed within our institution from May 2015 to August 2020. We reviewed the associations between the occurrence of sPPH requiring invasive treatment with clinical factors such as the maternal background and the characteristics of the lesions. Results The range of gestational age at delivery in our study was 12–21 weeks in 61 cases, 22–36 in 5, and 37 or later in 30. Among them, nine cases required invasive procedures for treatment. The onset of sPPH was within one month of delivery in all but two cases, with a median of 24 days (range 9–47). We found significant differences between requirements for invasive versus non-invasive strategies according to gestational age at delivery, assisted reproductive technology (ART) pregnancy, amount of blood loss at delivery, and the long axis of the RPOC-ARC lesion (p = 0.028, p = 0.009, p = 0.004, and p = 0.002, respectively). Multivariate analysis showed that only the long axis of the lesion showed a significant difference (p = 0.029). The Receiver Operating Characteristic (ROC) curve for predicting the need for invasive strategies using the long axis of the lesion showed that with a cutoff of 4.4 cm, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) was 87.5, 90.0, 43.8, and 98.7%, respectively. Conclusion The long axis of the RPOC-ARC is a simple indicator for predicting which sPPH will require invasive procedures, which use is rare in cases with lesions less than 4.4 cm or those occurring after the first postpartum month. Conservative management should be considered in such cases.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The RPOC long axis is a simple indicator for predicting the need of invasive strategies for secondary postpartum hemorrhage in either post-abortion or post-partum women: a retrospective case control study

Kobayashi

Nakagawa

Kawanishi

et al. 2021

BMC Pregnancy Childbirth

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“…While uterine atony is the predominant cause of primary PPH, retained products of conception is the leading cause of secondary PPH [2,[7][8][9] . Other causes of secondary PPH are primary subinvolution of placental bed, endometritis, pseudoanuerysm of the uterine artery, non union of uterine incision etc [10][11][12][13] . In contrast to primary PPH, the published work on the management of secondary PPH is limited [14] .…”

Section: Introductionmentioning

confidence: 99%

Secondary postpartum haemorrhage in a tertiary care hospital: A retrospective study

Dogra¹,

Kumar²,

Pandita³

2020

Int. J. Clin. Obstet. Gynaecol.

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Introduction: Postpartum haemorrhage is one of the leading causes of maternal mortality both in developing and developed countries. Although primary PPH is studied a lot but data regarding secondary PPH is sparse. Aims and objectives: Objective of our study was to find the incidence, causes and outcome of patients of secondary PPH. Methods: A retrospective study was carried out in SMGS Hospital, GMC Jammu over a period of 2 years from January 2017 to December 2019. Results: sixty two patients with secondary PPH were studied out of whom 72% were delivered vaginally. Maximum patients belong to age group of 20-28 years and 43% were P1. Retained products of conception was the leading cause in 68% of patients followed by endometritis in 21%. Mean haemoglobin concentration was 8.2+1.5g. curettage was done in 61% of patients. 18 patients required blood transfusion. Hysterectomy was done in 1 patient. None of the patient died. Conclusions: Secondary PPH is an important cause of maternal morbidity and mortality. Basic resuscitation followed by investigation and treatment of the specific cause can reduce the morbidity and mortality. Retained products of conception were a leading cause of secondary PPH in our study which is probably related to poor management of third stage of labour. It signifies that there is crucial role of active management of third stage of labour in preventing secondary PPH. Our study confirms that primary PPH is a risk factor for secondary PPH, so every effort should be made to prevent primary PPH. If medical intervention is sought early prognosis can be improved.

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“…ostpartum hemorrhage (PPH) is an obstetric emergency. It is one of the top five causes of maternal mortality in both high and low per capita income countries, although the absolute risk of death from PPH is much lower in high-income countries [1] . PPH occurring in the first 24 hours after delivery may be called primary or early PPH, PPH occurring from 24 hours to 12 weeks after delivery is usually called secondary, late, or delayed PPH [1] .…”

Section: Introductionmentioning

confidence: 99%

“…It is one of the top five causes of maternal mortality in both high and low per capita income countries, although the absolute risk of death from PPH is much lower in high-income countries [1] . PPH occurring in the first 24 hours after delivery may be called primary or early PPH, PPH occurring from 24 hours to 12 weeks after delivery is usually called secondary, late, or delayed PPH [1] . PPH is formally defined as the loss of at least 500 ml of blood after a vaginal birth or the loss of at least 1,000 ml of blood after a cesarean section within 24 hours of delivery [2].…”

Section: Introductionmentioning

confidence: 99%

Incidence and outcome of primary postpartum hemorrhage at Zagazig University Hospitals

Ahmed

Saleh

Elhameid

et al. 2019

Zagazig University Medical Journal

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Background: postpartum hemorrhage (PPH) is an obstetrical emergency that can occur after vaginal or cesarean delivery. It is the most common cause of maternal morbidity and may be complicated by shock, renal failure, acute respiratory distress syndrome, coagulopathy, and Sheehan syndrome. PPH is one of the top five causes of maternal death in both developed and developing countries. The Aim of work to assess the incidence and outcome of primary PPH in Zagazig University Hospitals to assess magnitude of the problem. Methods: This is a prospective cohort clinical study which was conducted in Zagazig University Maternity Hospital. Cases diagnosed with primary post partum haemorrage who delivered at or admitted to maternity hospital at Zagazig University Hospitals. Results: 3000 cases were admitted either delivered at our hospital or outside and admitted for immediate post partum hemorrhage, 74 cases were diagnosed by immediate post partum hemorrhage (2.5%). percentage of PPH in our study was found to be 2.5%, the most common causes of PPH are uterine atony 71.6% , obstetric trauma 18.9%, the most common risk factors for PPH are placenta previa 28.4%, PIH 21.6%, Anemia 18.9%, 10.8% experienced previous postpartum hemorrhage, the majority of the studied women had no medical problems (75%), there was significant relation between PPH occurrence and past medical history, anemia and previous PPH, the tertiary care was the commonest place for delivery followed by private (94.6% and 4.1% respectively), 49 patients received 1_5 units blood (66.2%), 50 patients have moderate degree of shock (67.5%).Conclusion: primary PPH was found to be 2.5%, most common causes of PPH are uterine atony 71.6% , obstetric trauma 18.9%.

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Severe Secondary Postpartum Hemorrhage: A Historical Cohort

Cited by 8 publications

References 0 publications

The RPOC long axis is a simple indicator for predicting the need of invasive strategies for secondary postpartum hemorrhage in either post-abortion or post-partum women: a retrospective case control study

The RPOC long axis is a simple indicator for predicting the need of invasive strategies for secondary postpartum hemorrhage in either post-abortion or post-partum women: a retrospective case control study

Secondary postpartum haemorrhage in a tertiary care hospital: A retrospective study

Incidence and outcome of primary postpartum hemorrhage at Zagazig University Hospitals

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