GuidelinesOther guideline
Secondary Postpartum Haemorrhage
The guidelines recommend management of common obstetric conditions at primary and referral level, based on local experience and evidence-based practice. They are not intended as strict protocols nor as standard operating procedures, but rather as a guide to safe effective management of common obstetric problems. The guidelines should be most useful to interns, medical officers and registrars.
This is passage of fresh blood or clots from the vagina >24 hours after delivery. The common causes are placental site subinvolution, endometritis, retained products of conception & wound breakdown.
Management of secondary postpartum haemorrhage
- Resuscitate the woman if she is shocked or has bled excessively, as for primary postpartum haemorrhage
- Give oxytocin & ergometrine as for primary PPH
- Find out if the placenta & membranes were complete after delivery
- Carefully examine the vulva & vagina for a source of bleeding
- If the cervix is open, attempt to feel inside the uterus for retained products
- If the cervix is open in the first week after delivery, this is normal & not necessarily a sign of retained products
- Do a transabdominal ultrasound scan where there is uncertainty about retained products, to confirm or exclude retained placental tissue
- Specific treatment will be directed at the cause: antibiotics for endometritis, repair of wounds, or evacuation of retained products