title: Severe secondary postpartum hemorrhage: a historical cohort.
abstract: OBJECTIVE
  The principal objective of our study was to describe the frequency of severe secondary postpartum hemorrhages (PPH). Our secondary objectives were to describe the different causes of PPH and to assess if the PPH etiologies varied by parity.
  
  
  METHODS
  This is a historical cohort study covering the period from January 1, 2004, through February 13, 2013, in a level III maternity ward. Women were eligible if they were treated for severe secondary PPH during their postpartum hospitalization or were admitted for it after discharge but before the 42nd day postpartum, regardless of the type of delivery. Women were excluded if they gave birth before 22 weeks of gestation or if they had experienced only an immediate PPH (≤ 24 hours after delivery). Eligible patients were identified by the hospital's administrative software. Primiparas and multiparas were compared with Student's t test and a chi-squared or Fisher's exact test.
  
  
  RESULTS
  The incidence of severe secondary PPH was 0.23 percent (n = 60/26,023). The mean time between delivery and PPH onset was 13.4 ± 10.8 days. The women's mean age was 30.4 ± 5.7 years and their mean body mass index was 23.4 ± 5.7 kg/m². Placental retention was the cause to which these hemorrhages were most frequently attributed (30.0%). Subinvolution of the placental bed was noted in 13.3 percent of the patients, endometritis in 10.0 percent, pseudoaneurysm of the uterine artery in 3.3 percent, and excessively strong resumption of menses in 3.3 percent; no cause could be determined for 16.7 percent of the cases. Neither clinical signs nor causes differed by parity.
  
  
  CONCLUSIONS
  Secondary PPH is rare. Accurate diagnosis is based most often on histopathologic findings.
authors: EA 4681, PEPRADE, University of Auvergne, Clermont-Ferrand, France.
authors: Mathieu
authors: M
authors: Dossou
authors: Department of Public Health, Clermont-Ferrand University Hospital Center, Clermont-Ferrand, France.
authors: Anne
authors: A
authors: Debost-Legrand
authors: Department of Fetal Pathology, University Hospital Center, Clermont-Ferrand, France.
authors: Pierre
authors: P
authors: Déchelotte
authors: EA 4681, PEPRADE, University of Auvergne, Clermont-Ferrand, France.|Department of Obstetrics & Gynecology, Clermont-Ferrand University Hospital Center, Clermont-Ferrand, France.
authors: Didier
authors: D
authors: Lémery
authors: EA 4681, PEPRADE, University of Auvergne, Clermont-Ferrand, France.|Department of Public Health, Department of Obstetrics & Gynecology, Clermont-Ferrand University Hospital Center, Clermont-Ferrand, France.|AUDIPOG Sentinel Network, Medical university RTH Laennec, Lyon, France.
authors: Françoise
authors: F
authors: Vendittelli
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D010298:Parity; D063886:Patient Discharge Summaries / Q000706:statistics & numerical data; D018457:Placenta, Retained / Q000453:epidemiology / Q000473:pathology; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D011247:Pregnancy; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: delivery; placenta; placental bed subinvolution; secondary postpartum hemorrhage