title: [Secondary postpartum hemorrhage].
abstract: OBJECTIVE
  To define secondary postpartum hemorrhage (HSPP), to discuss its main etiologies and suggest a proposal for its management.
  
  
  METHODS
  Bibliographic research by crossing keywords: secondary postpartum hemorrhage, delayed postpartum hemorrhage, postpartum bleeding, placental remnant, placental and hysteroscopy.
  
  
  RESULTS
  The HSPP (0.5 and 2%) is defined as bleeding occurring between 24hours and 6weeks after birth and requiring therapeutic action whatsoever (professional consensus). The most common etiology is retained placental fragments and/or endometritis, associated or not with incomplete uterine involution (Professional consensus). Among other etiologies: the pseudoaneurysms of the uterine artery, arteriovenous fistulae's, choriocarcinoma and coagulopathies. Management of HSPP depends on its etiology and the severity of bleeding. It includes antibiotics (grade A) and uterotonics (professional consensus). Antibiotherapy depends of the protocols of each department. Usually the patient will be hospitalized (Professional consensus). In case of persistent bleeding, suction curettage with or without hysteroscopy is recommended (Professional consensus).
  
  
  CONCLUSIONS
  Although HSPP is an important source of maternal morbidity, it is concerned by a relatively few number of studies in the literature. Its management is based on a comprehensive etiological work-up in order to provide appropriate treatment.
authors.affiliation: Département de gynécologie-obstétrique, hôpital de Hautepierre, avenue Molière, 67098 Strasbourg, France.
authors.forename: C Y
authors.initials: CY
authors.lastname: Akladios
authors.affiliation: Département de gynécologie-obstétrique, hôpital de Hautepierre, avenue Molière, 67098 Strasbourg, France.
authors.forename: N
authors.initials: N
authors.lastname: Sananes
authors.affiliation: Département de gynécologie-obstétrique, hôpital de Hautepierre, avenue Molière, 67098 Strasbourg, France.
authors.forename: A
authors.initials: A
authors.lastname: Gaudineau
authors.affiliation: Département de gynécologie-obstétrique, hôpital de Hautepierre, avenue Molière, 67098 Strasbourg, France.
authors.forename: E
authors.initials: E
authors.lastname: Boudier
authors.affiliation: Département de gynécologie-obstétrique, hôpital de Hautepierre, avenue Molière, 67098 Strasbourg, France. Electronic address: bruno.langer@chru-strasbourg.fr.
authors.forename: B
authors.initials: B
authors.lastname: Langer
mesh_terms: D005260:Female; D006801:Humans; D006473:Postpartum Hemorrhage / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D017410:Practice Guidelines as Topic / Q000592:standards*
keywords: Delayed postpartum hemorrhage; Endometritis; Endométrite; Fragments placentaires; Hémorragie du post-partum retardée; Hémorragie du post-partum secondaire; Placenta; Placental remnant; Postpartum bleeding; Secondary postpartum hemorrhage