No randomised controlled trials to inform the management of women with secondary postpartum haemorrhage
Sometimes women experience abnormal or excessive bleeding from the birth canal between 24 hours and 12 weeks after giving birth, and this is called secondary postpartum haemorrhage. It is usually caused by a tear, an infection, or by fragments of the placenta or membranes, or both, remaining in the uterus and causing infection or preventing the uterus from contracting. It can be painful, disruptive to daily life with a new baby and can exacerbate extreme tiredness. Although the specific incidence is not known, in low-income countries it is probably a serious cause of maternal mortality. In high-income countries, about 2% of women are admitted to hospital with this condition. Treatments may include giving drugs to treat infection and/or control bleeding and/or a variety of surgical procedures. Studies could have compared an individual treatment to another, combinations of treatments to others, and any individual or combination of treatments to either a placebo or no treatment group. However, no trials were identified and so there is no good evidence on which to base guidance. A well-designed trial is needed.