Severe Secondary Postpartum Hemorrhage: A Historical Cohort

ObjectivesThe principal objective of our study was to describe the frequency of severe secondary postpartum hemorrhages (PPH). Our secondary objectives were to describe the different causes of PPH and to assess if the PPH etiologies varied by parity. MethodsThis is a historical cohort study covering the period from January 1, 2004, through February 13, 2013, in a level III maternity ward. Women were eligible if they were treated for severe secondary PPH during their postpartum hospitalization or were admitted for it after discharge but before the 42nd day postpartum, regardless of the type of delivery. Women were excluded if they gave birth before 22weeks of gestation or if they had experienced only an immediate PPH (24hours after delivery). Eligible patients were identified by the hospital's administrative software. Primiparas and multiparas were compared with Student's t test and a chi-squared or Fisher's exact test. ResultsThe incidence of severe secondary PPH was 0.23 percent (n=60/26,023). The mean time between delivery and PPH onset was 13.410.8days. The women's mean age was 30.4 +/- 5.7years and their mean body mass index was 23.4 +/- 5.7kg/m(2). Placental retention was the cause to which these hemorrhages were most frequently attributed (30.0%). Subinvolution of the placental bed was noted in 13.3 percent of the patients, endometritis in 10.0 percent, pseudoaneurysm of the uterine artery in 3.3 percent, and excessively strong resumption of menses in 3.3 percent; no cause could be determined for 16.7 percent of the cases. Neither clinical signs nor causes differed by parity. ConclusionSecondary PPH is rare. Accurate diagnosis is based most often on histopathologic findings.