In plain words
Secondary postpartum hemorrhage is bleeding that is heavy or abnormal and starts more than 24 hours after birth, up to 12 weeks postpartum. The bleeding that follows birth, called , is expected for several weeks. Secondary hemorrhage is different. It can be a sudden gush, large clots, or bleeding that soaks through pads quickly. Causes include pieces of placenta or membranes left in the uterus, , and problems with healing. The line between normal and concerning is judged by the amount, the pattern, and how the mother feels. Mothers are usually told to call their provider or go in when bleeding is heavy or they feel unwell.
The deeper version
ACOG (Practice Bulletin 183, 2017) defines secondary postpartum hemorrhage as abnormal or excessive uterine bleeding occurring between 24 hours and 12 weeks after delivery. It is reported in a small minority of births, with rates depending on the definition used. Principal causes are retained placental tissue or membranes, endometritis, , and, rarely, vascular malformation. Evaluation includes history, examination, pelvic ultrasound for retained tissue, and measurement, with treatment matched to cause. Clinically it must be distinguished from normal lochia, and it must be recognized alongside endometritis, because untreated cases can progress. Acute blood loss can also lead to anemia and, rarely, to pituitary injury.
Where it comes up
- Postpartum bleeding (lochia): what's normal, what's notPostpartum: Your Body
- Heavy bleeding after birth (hemorrhage)Birth and the First Days
- Postpartum warning signs: the one-page listPostpartum: Your Body
- When your period comes backPostpartum: Your Body
- Leaving the house for the first timeSupport, Home, and Village
- Holidays, travel, and events with a newbornSupport, Home, and Village
What mothers here say about secondary postpartum hemorrhage
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Sources
- American College of Obstetricians and Gynecologists — Practice Bulletin 183: Postpartum Hemorrhage, 2017