Secondary postpartum haemorrhage: incidence, morbidity and current management

BJOG. 2001 Sep;108(9):927-30. doi: 10.1111/j.1471-0528.2001.00230.x.


Objective: To determine the incidence, risk factors, presentation, treatment and morbidity associated with secondary postpartum haemorrhage.

Design: Analysis of 132 consecutive women presenting with secondary postpartum haemorrhage occurring over a three-year period.

Setting: The maternity unit in a district general teaching hospital serving an annual delivery rate of around 6500 women.

Main outcome measures: Factors associated with the cause of the haemorrhage and the resulting morbidity.

Results: Most women presented during the second week after delivery. A history of primary postpartum haemorrhage (OR 9.3; 95% CI 6.2-14.0) and manual removal of placenta (OR 3.5; 95% CI 1.6-7.5) were the only significant risk factors identified. There was a high associated morbidity, with 84% requiring hospital admission, 63% surgical evacuation, 17% blood transfusion, with three women suffering a uterine perforation, one managed by hysterectomy. In women undergoing evacuation only, 37% had retained placental tissue confirmed after surgery; pre-operative ultrasound examination did not provide a better discrimination over clinical assessment for this finding.

Conclusions: Secondary postpartum haemorrhage occurs in just under 1% of women, is associated with primary postpartum haemorrhage and retained placenta, and may result in significant maternal morbidity. This problem deserves more attention than it has received in recent years.

MeSH terms

  • Blood Transfusion
  • England / epidemiology
  • Female
  • Hospitals, District
  • Hospitals, Maternity
  • Humans
  • Incidence
  • Placenta, Retained / complications
  • Placenta, Retained / therapy
  • Postnatal Care / organization & administration*
  • Postpartum Hemorrhage / epidemiology
  • Postpartum Hemorrhage / etiology
  • Postpartum Hemorrhage / therapy*
  • Pregnancy
  • Recurrence
  • Risk Factors