title: Postnatal vaginal bleeding problems and General Practice.
abstract: OBJECTIVE
  to investigate women's experiences of problems with vaginal loss from 28 days to three months postnatally and to describe the treatment and referral patterns for women who consult their GP about such problems during the first three months postnatally.
  
  
  METHODS
  a longitudinal questionnaire study of consecutively delivered postnatal women and a report-card survey of GP consultations by women with problems with postnatal vaginal loss.
  
  
  METHODS
  two health districts in the south of England.
  
  
  METHODS
  women delivering in the two health districts during specified recruitment periods in 1995 and 1996. For the GP study, with her consent, the GP returned an anonymous registration card for each woman presenting.
  
  
  RESULTS
  in the survey of women, 20% (64/325) reported problems with postnatal loss occurring between 28 days and three months after the birth. Around a half of these consulted a GP. The GP study was disappointing in that only 26% (30/115) of practices agreed to take part and 16% (18/115) returned notification cards. Forty-eight women were included from 18 practices. The most common presenting symptoms were excessive bleeding (29/48; 60%) and prolonged bleeding (26/48; 54%). The commonest form of treatment was antibiotics alone (15/48; 31%) but 12 women (25%) were neither treated nor referred. Referral (n=19) was for hospital admission, out-patient appointment or direct referral for an ultrasound scan.
  
  
  CONCLUSIONS
  morbidity related to abnormalities of postnatal vaginal fluid loss (lochia) has been shown to be significant, yet nothing was known about the outcome of related GP consultations during the first three months postnatally. A variety of treatment and referral patterns were revealed, highlighting the need for a systematic review of the literature on the management of secondary postpartum haemorrhage. Health care workers need to be aware of the significant morbidity experienced by postnatal women in relation to their lochial loss.
authors.affiliation: Bournemouth University, Dorset, BH1 3LG, UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Marchant
authors.forename: Jo
authors.initials: J
authors.lastname: Alexander
authors.forename: Jo
authors.initials: J
authors.lastname: Garcia
mesh_terms: D000293:Adolescent; D000328:Adult; D004739:England; D005194:Family Practice / Q000592:standards; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D011181:Postnatal Care / Q000592:standards*; D006473:Postpartum Hemorrhage / Q000175:diagnosis* / Q000628:therapy*; D010818:Practice Patterns, Physicians'; D011787:Quality of Health Care; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D013997:Time Factors