Highlights
- •Secondary postpartum haemorrhage is a significant cause of postnatal morbidity.
- •Management may include medical, surgical, or interventional radiological techniques.
- •There is minimal, low-quality evidence available to guide management of secondary postpartum haemorrhage.
- •Future, well-designed prospective studies are required.
Abstract
Secondary postpartum haemorrhage is a significant cause of postnatal morbidity and
admission to hospital. It can be managed medically, surgically or with interventional
radiological techniques, however, there is limited evidence to inform the most appropriate
use of these treatments. This review aimed to summarise the existing evidence and
evaluate the effectiveness and safety of the management options available for secondary
postpartum haemorrhage.
MEDLINE, EMBASE, CENTRAL, SCOPUS, Clinicaltrials.gov and ICTRP were searched from
conception to August 2021. Eligible studies described the management of participants
with secondary postpartum haemorrhage occurring between 24 h and 12 weeks after a
pregnancy of at least 20 weeks gestation. All treatment interventions were eligible.
Outcomes included reduction of bleeding, hospital admissions, re-presentations to
hospital, secondary surgical procedures, blood transfusions, adverse effects of treatment,
surgical complications, hysterectomy, ICU admissions, severe morbidity and mortality.
The protocol for this review was registered with PROSPERO (ID: CRD42021274146).
Eleven studies, describing 834 participants, were eligible for inclusion. Five studies
reported outcomes of a single intervention and six studies reported outcomes of more
than one treatment modality. Assessed interventions included medical management, surgical
procedures, and radiological techniques. Resolution of bleeding was seen in 8.2–84.6 %
of participants following medical management, 89.3–100 % following surgical management
and 87.5–100 % post transcatheter arterial embolisation. When considering only studies
published in the last 30 years, these results are 71.9–73.7 %, 89.3–92.0 % and 87.5–100 %
respectively. All included studies were small and retrospective observational in design
with poor methodological quality leading to a serious or critical risk of bias.
This review has highlighted the deficiencies in evidence for the management of secondary
PPH. Future, well designed, prospective studies are needed to provide guidance to
clinicians managing this condition.
Abbreviations:
D&C (dilation and curettage), HDU (high dependency unit), ICU (intensive care unit), PPH (postpartum haemorrhage), TAE (transcatheter arterial embolisation)Keywords
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Article info
Publication history
Published online: January 23, 2023
Accepted:
January 22,
2023
Received in revised form:
January 14,
2023
Received:
November 10,
2022
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
