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Secondary postpartum haemorrhage — DRCOG MCQ

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HardPostnatal CareSecondary postpartum haemorrhageDRCOG

Nine days after a forceps birth, a woman develops fresh heavy vaginal bleeding with clots, fever and a tender, subinvoluted uterus. What is the most appropriate management?

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Correct answer: E — Arrange urgent maternity assessment for secondary postpartum haemorrhage today

The best answer is “Arrange urgent maternity assessment for secondary postpartum haemorrhage today”. Heavy bleeding between 24 hours and 12 weeks after birth is secondary postpartum haemorrhage and, with fever, tenderness and subinvolution, may reflect infection or retained products. She needs urgent maternity assessment, resuscitation if unstable and investigation with treatment directed at the cause. Oral iron alone or delayed imaging is unsafe.

Reference: NICE NG194: Postnatal care: https://www.nice.org.uk/guidance/ng194/chapter/Recommendations