Treatments for secondary postpartum haemorrhage

No randomised controlled trials to inform the management of women with secondary postpartum haemorrhage

Sometimes women experience abnormal or excessive bleeding from the birth canal between 24 hours and 12 weeks after giving birth, and this is called secondary postpartum haemorrhage. It is usually caused by a tear, an infection, or by fragments of the placenta or membranes, or both, remaining in the uterus and causing infection or preventing the uterus from contracting. It can be painful, disruptive to daily life with a new baby and can exacerbate extreme tiredness. Although the specific incidence is not known, in low-income countries it is probably a serious cause of maternal mortality. In high-income countries, about 2% of women are admitted to hospital with this condition. Treatments may include giving drugs to treat infection and/or control bleeding and/or a variety of surgical procedures. Studies could have compared an individual treatment to another, combinations of treatments to others, and any individual or combination of treatments to either a placebo or no treatment group. However, no trials were identified and so there is no good evidence on which to base guidance. A well-designed trial is needed.

Authors' conclusions: 

No information is available from randomised controlled trials to inform the management of women with secondary postpartum haemorrhage. This topic may have received little attention because it is perceived as being associated with maternal morbidity rather than mortality in developed countries; it is only recently that the extent and importance of postnatal maternal morbidity has been recognised. A well-designed randomised controlled trial comparing the various therapies for women with secondary postpartum haemorrhage against each other and against placebo or no treatment groups is needed.

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Background: 

Secondary postpartum haemorrhage is any abnormal or excessive bleeding from the birth canal occurring between 24 hours and 12 weeks postnatally. In developed countries, 2% of postnatal women are admitted to hospital with this condition, half of them undergoing uterine surgical evacuation. Data are not available from developing countries.

Objectives: 

To evaluate the relative effectiveness and safety of the treatments used for secondary postpartum haemorrhage.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2008), the reference lists of trial reports and reviews and sought further sources from the first named authors of the papers identified.

Selection criteria: 

All randomised or quasi-randomised comparisons between drug therapies, surgical therapies and placebo or no treatment for the management of secondary postpartum haemorrhage occurring between 24 hours and three months following a pregnancy of at least 24 weeks' gestation.

Data collection and analysis: 

Two authors scrutinised reports of possibly eligible studies. The third author acted as an advisor or arbitrator.

Main results: 

Of the 47 papers (36 studies) identified, none met the inclusion criteria.

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