Surgical versus medical treatment for secondary post-partum hemorrhage.
BACKGROUND
Secondary post-partum hemorrhage (PPH) is defined as any abnormal bleeding from the birth canal occurring between 24 hours and 12 weeks postnatally. Treatment usually falls into one of the two categories: surgical evacuation of the uterus or medical treatment.


OBJECTIVE
To compare the two different clinical approaches and the implications on future fertility.


METHODS
A retrospective study.


METHODS
From 1990 to 2002, 168 women diagnosed with late PPH were admitted to the Hadassah Medical Centers in Jerusalem. The cases were divided into two groups according to the planned initial treatment: primary surgical treatment vs. primary medical treatment.


RESULTS
Primary surgical treatment was associated with significantly more primary negative events (p=0.01). After the primary event, primary surgical treatment was associated with fewer future deliveries (p=0.04) and resulted in increased rate of secondary infertility of borderline significance (p=0.06).


CONCLUSIONS
Our results show that secondary PPH is related to high rates of immediate and long-term complications. It is possible that a conservative medical approach for secondary PPH may be superior to surgical treatment.
Feigenberg
Tomer
T
The Departments of Obstetrics and Gynecology, Hadassah Ein-Kerem Medical Center, The Hebrew University, Ein-Kerem, Jerusalem, Israel. feigenberg@013.net
Eitan
Yael
Y
Sela
Hen Y
HY
Elchalal
Uriel
U
Ben-Meir
Assaf
A
Rojansky
Nathan
N
D000328:Adult; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000009:adverse effects; D005260:Female; D006489:Hemostatic Techniques; D006801:Humans; D007044:Hysterectomy; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D012008:Recurrence; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome