What is secondary postpartum haemorrhage, and what are its common causes?

Secondary postpartum haemorrhage is abnormal/excessive bleeding from the genital tract between 24 hours and 6 weeks (12 weeks) after delivery.

The commonest causes are retained products of conception and endometritis (infection) - often together; it presents with heavy/prolonged or offensive bleeding and is managed with antibiotics, uterotonics, and evacuation of retained products if needed.

Clinical relevance. Recognising secondary PPH (retained products/endometritis) guides antibiotics and evacuation, preventing severe bleeding/sepsis.

More Detail

Secondary postpartum haemorrhage

This is a common late postpartum complication, distinct from primary (first-24-hour) PPH.

Definition

• Abnormal or excessive bleeding from the genital tract between 24 hours and 6 weeks (up to 12 weeks) after delivery.

Common causes

• Retained products of conception (retained placental tissue/membranes).
• Endometritis (uterine infection) - often coexists with retained products.
• Less commonly: subinvolution of the placental site, gestational trophoblastic disease, or a bleeding disorder.

Presentation and management

• Heavy, prolonged, or recurrent bleeding, often with offensive lochia, fever and abdominal pain (if infected).
• Assess (examination, ultrasound for retained products, swabs/bloods).
• Antibiotics (for endometritis), uterotonics, and surgical evacuation of retained products if significant retained tissue; resuscitate if heavy bleeding.