PF for PPH (134/1700)

A 32yo had a normal vaginal delivery 10 days ago. Her uterus has involuted normally. Choose
the single most likely predisposing factor for PPH?
a. Retained product
b. DIC
c. Uterine infection
d. Von Willebrand disease
e. Primary PPH


































Correct answer: C
only a or c can be causes of 2ndry PPH , but since uterus involuted normally, there is unlikely any retained product

Secondary postpartum haemorrhage

This commonly presents in primary care as prolonged or excessive bleeding once the woman has returned home after delivery.

Aetiology

The two most common causes are:

• Infection - endometritis. This occurs in 1-3% after spontaneous vaginal delivery. It is the most common cause of postnatal morbidity between day 2 and day 10. Risk factors are:
  • Caesarean section, prolonged rupture of membranes, severe meconium staining in liquor, long labour with multiple examinations, manual removal of placenta, mother's age at extremes of the reproductive span, low socio-economic status, maternal anaemia, prolonged surgery, internal fetal monitoring and general anaesthetic.
• Retained products of conception (RPOC).