Abstract
Objectives: To determine the various factor associated with secondary PPH and to evaluate the medical or surgical intervention needed in secondary PPH.
Methods: The study was a hospital based, carried out in a tertiary hospital of Manipur, Regional Institute of Medical Sciences, Imphal. It was a prospective longitudinal study. It was conducted during the period of November 2014 to April 2016. Sixty five women with bleeding per vagina with a diagnosis of secondary postpartum haemorrhage and subsequently getting admitted during the study period were included in the study.
Results: In the study conducted, the majority of women were in the age group of 20-30 year (63.1%).The mean age was 27.±6.04. Parity in the present study did not influence the incidence of secondary PPH, and the distribution of its causes was the same in both primiparous and multiparous women. In 17(26.2%) secondary PPH presented less than 7 days of delivery, 24(36.9%) within 8-14 days, 14(21.5%) within 15-21 days,4(6.2%) within 22-28 days and 6(9.2%) beyond 29 days with P=15.91±9.30. The cause of secondary postpartum haemorrhage was retained bits of membrane 24(36.9%%), retained placental tissue 14(21.5%%), purpural sepsis 8(12.3%) and subinvolution of the uterus 19(29.2%).Out of 65 women with secondary PPH 32(49.2%) women received medical treatment in the form of uterotonic drugs and administration of antibiotic. Surgical treatment was given to 33(49.2%)women, check evacuation was done on 26(40%) women, Dilatation and evacuation(D&C) in 4 (6.2%), placental tissue were removed digitally in 2(3.1%) where the cervical os was open and haemostaic suture was taken in 1(1.5%) women with bleeding from the right cervical angle.
Conclusion: Secondary PPH is a rare complication but one that can result in severe maternal morbidity. We found that retained placental tissue and bits of membrane were the commonest cause of secondary PPH followed by subinvolution of the uterus and puerperal sepsis. Medical and surgical intervention were required in almost all the cases with equal frequency.
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Corresponding Author
Dr Haelom Liegise
Former Junior Resident, Dept of Obstetrics and Gynaecology, R.I.M.S Imphal, Manipur
DOI: https://dx.doi.org/10.18535/jmscr/v6i12.51
