Secondary postpartum hemorrhage

Secondary postpartum hemorrhage usually results from an infective process within the decidua and myometrium, typically due to retained placental tissue fragments. The latter is suspected from subinvolution of the uterus and an open cervix through which tissue fragments may be found. Initial management is the taking of bacterial cultures, intravenous fluids, and blood, and antibiotics (e.g. Augmentin, or a cephalosporin and metronidazole) proceeding to exploration of the uterus. Ultrasound examination of the uterus is helpful to reduce the proportion of women undergoing exploration, but this should be done by an obstetrician with experience who is actively involved in the clinical management. Hemorrhage occurs from vessels in the infected myometrium; therefore the uterotonic measures outlined above for primary postpartum hemorrhage may be ineffective. A substantial secondary postpartum hemorrhage is more likely to result in hysterectomy than is a primary postpartum hemorrhage.

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