Delayed postpartum hemorrhage: A retrospective analysis

This investigation sought to characterize the syndrome of severe delayed postpartum hemorrhage. We defined the syndrome as hemorrhage requiring hospitalization and/or surgical intervention, occurring after the patients' initial hospital discharge. We evaluated hospital admissions to two tertiary institutions. During a 10-year period, 113 women (57,089 deliveries) suffered severe delayed postpartum hemorrhage. The incidence of the syndrome was 0.2% of deliveries. The mean time of presentation of delayed hemorrhage was 18 days post-delivery. However, 11% of bleeding began 6 weeks or more after delivery. Curettage was an effective management, with successful resolution of symptoms in 91 of 99 patients. Histologic examination of curettage material demonstrated retained products of conception in 55% of cases; 35% of patients required transfusion. Pre-existing medical diseases were not associated with postpartum bleeding. The only predisposing cause was postpartum hemorrhage that had occurred at delivery (22 patients); 19 of these women were later found to have retained products of conception. Combining our series with other series reported in the literature, severe delayed postpartum hemorrhage occurs in 0.2-0.5% of deliveries. Major etiologies include retained products of conception 30-50% of the time, as well as subinvolution of the placenta. Uterine curettage is an effective management option.