Impact of Delivery Methods and Antenatal Care on the Incidence of Secondary Postpartum Hemorrhage

Background: Secondary postpartum hemorrhage (PPH) defined as excessive vaginal bleeding from 24 hours after delivery up to 6 weeks postpartum, continues to be a major cause of maternal morbidity and mortality. Exploration of its causes and risk factors is essential to inform more effective prevention and management strategies, particularly in resource limited settings. This study aimed to assess the effectiveness of delivery methods, antenatal care and other related factors in determining incidence of secondary PPH. Methods: A descriptive cross sectional study was conducted in the Department of Obstetrics and Gynaecology of BSMMU, Dhaka during the period from March 2012 to August 2012. A total of 42 women with secondary PPH were included based on inclusion and exclusion criteria. The data were collected by means of structured interviews, clinical examinations and medical record reviews. Maternal age, delivery methods, timing and causes of secondary PPH were analyzed. Results: Secondary PPH was found most commonly during the second (38.1%), and third (28.57%) weeks postpartum. The leading causes were infections (52.38%), retained placental tissue (23.81%), uterine atony (16.67%), and lower genital tract injuries (7.14%). Women with inadequate antenatal care (61.9%) and who delivered vaginally (57.14%) had greater risk of secondary PPH. Cesarean deliveries contributed to 38.1% of cases. Conclusion: Infections, inadequate antenatal care and delivery methods are strongly associated with secondary PPH. Improving antenatal care, skilled care during delivery and postpartum monitoring can significantly reduce its occurrence and complications.