Late postpartum hemorrhage

Abstract

As defined in this paper, late postpartum hemorrhage indicates prolonged or excessive uterine bleeding beginning after the first day following delivery. The attempts of other authors (Roberton and Kleinwachter1) to extend the interval to reach from the first to the twenty-eighth day postpartum, and to subgroup an early and later type, offer no advantages. The frequency of l.p.p.h.††Late postpartum hemorrhage, elsewhere designated by l.p.p.h. is difficult to ascertain because of the paucity of reports. Williams13 and DeLee14 make only brief mention of the subject, while Davis and Schuman omit any reference to its occurrence. In American literature only one report by N. H. Williams appeared on this subject since 1939.12 Chiare and Roberton1 record an incidence of 1:250 to 1:300 for the late group of postpartum hemorrhage from all causes. This paper, however, excludes cases of l.p.p.h. from ruptured varicies or atheromatous vessels, from coincidental tumors (fibroids or carcinoma), from lacerations (cervical, perineal, and vulval), and from uterine inversion.It deals with late postpartum bleeding due to: (1) Retained placental fragments. Focal placental accreta is not recorded in this group, but there is one case of a retained succenturiate lobe. The remaining cases are fragments derived from normal placentas. (2) Uterine abnormalities in involution of the placental site. (3) Uterine abnormalities in retention and separation of the decidua vera.