Secondary postpartum hemorrhage

Objectives. - To define secondary postpartum hemorrhage (HSPP), to discuss its main etiologies and suggest a proposal for its management. Materials and methods. - Bibliographic research by crossing keywords: secondary postpartum hemorrhage, delayed postpartum hemorrhage, postpartum bleeding, placental remnant, placental and hysteroscopy. Results. - The HSPP (0.5 and 2%) is defined as bleeding occurring between 24 hours and 6 weeks after birth and requiring therapeutic action whatsoever (professional consensus). The most common etiology is retained placental fragments and/or endometritis, associated or not with incomplete uterine involution (Professional consensus). Among other etiologies: the pseudoaneurysms of the uterine artery, arteriovenous fistulae's, choriocarcinoma and coagulopathies. Management of HSPP depends on its etiology and the severity of bleeding. It includes antibiotics (grade A) and uterotonics (professional consensus). Antibiotherapy depends of the protocols of each department. Usually the patient will be hospitalized (Professional consensus). In case of persistent bleeding, suction curettage with or without hysteroscopy is recommended (Professional consensus). Conclusion. - Although HSPP is an important source of maternal morbidity, it is concerned by a relatively few number of studies in the literature. Its management is based on a comprehensive etiological work-up in order to provide appropriate treatment. (C) 2014 Published by Elsevier Masson SAS.