A comparison of clinical assessment with ultrasound in the management of secondary postpartum haemorrhage

Objective: To compare the diagnostic accuracy of clinical assessment with transabdominal ultrasound in the management of secondary postpartum haemorrhage (PPH). Design: A prospective cohort study. Methods: Fifty-three women who presented to a teaching hospital obstetric unit with secondary PPH were studied. Patients were divided into those in whom retained placental tissue was or was not the suspected cause of bleeding. This diagnosis was based on history/examination and transabdominal pelvic ultrasound scan. The definitive diagnosis was made following uterine evacuation or was assumed in women who stopped bleeding without surgical management. Likelihood ratio (LR) was used as an accuracy measure. Results: The positive LR for clinical assessment was 5.5 (95% CI 2.7-12.1) compared with 2.4 (95% CI 1.5-3.7) for ultrasound. The negative LRs were 0.1 (95% CI 0.04-0.5) and 0.1 (95% CI 0.02-0.5) for clinical and ultrasound assessment, respectively. Conclusion: Clinical examination and ultrasound scan assessment have limited diagnostic accuracy in secondary PPH. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.