Secondary Postpartum Hemorrhage

Secondary postpartum hemorrhage, defined as excessive bleeding 24 hours to 6–12 weeks after delivery, remains an uncommon but clinically significant contributor to maternal morbidity. Retained products of conception is the most common cause, and primary postpartum hemorrhage and manual placental extraction in the index delivery before admission for secondary postpartum hemorrhage are associated risk factors. Ultrasound is widely incorporated into evaluation, with an echogenic intrauterine mass representing the most predictive finding; however, diagnostic criteria are not standardized. Management varies, with many patients initially receiving antibiotics and uterotonics; however, most ultimately undergo uterine evacuation. However, the available evidence is limited by retrospective study design, highlighting the need for standardized diagnostic approaches and prospective studies to inform optimal management.