A woman develops a secondary postpartum haemorrhage on day 14. Which single combination of causes is most likely?

Answer: A. Endometritis (infection) and/or retained products of conception

Secondary postpartum haemorrhage

Secondary PPH is abnormal bleeding from the genital tract after the first 24 hours and up to about 12 weeks postpartum.

Common causes

• Endometritis (infection) and/or retained products of conception.

Assessment and management

• Assess for fever, offensive lochia, subinvolution and a tender uterus; ultrasound for retained products.
• Treat with antibiotics for endometritis, and evacuation of retained products if present; resuscitate if bleeding is heavy.

Contrast

• Primary PPH (within 24 hours) is most often due to uterine atony.

So secondary PPH is commonly due to endometritis and/or retained products.