Secondary Postpartum Haemorrhage following vaginal delivery - a 3-year survey of causes and management.

OBJECTIVES: Secondary postpartum haemorrhage (PPH) is a serious complication of childbirth and a life-threatening condition that may lead to infertility amongst women during the reproductive age groups. The objective of this study is to highlight the underlying causes of secondary PPH and outcomes for patients who delivered vaginally, with the aim of reducing maternal mortality and morbidity. MATERIAL AND METHODS: This is a prospective cohort study conducted in the Department of Obstetrics and Gynaecology at AL-Yarmouk Teaching Hospital, Baghdad, Iraq. The study was conducted over a 3-year period from December 2015 to December 2018. Women who delivered vaginally with a gestational age of at least 24 weeks, with no previous caesarean or uterine scars, who were admitted to the hospital complaining of bleeding from their genital tracts after 24 hours of delivery, but prior to 6 weeks from delivery, were enrolled in the study. Patients received resuscitative measures and medical treatment and were observed regarding their response to medical treatment and whether they required surgical intervention. Types of management were also evaluated, and histopathological reviews were gathered and recorded for those who needed retained pieces of product evacuated or hysterectomies. RESULTS: Two hundred cases were analysed; the incidence of severe secondary postpartum haemorrhage was 60 per 10,000 deliveries. Endometritis was the leading cause (64% of patients), followed by retained placental pieces (13.5%); emergency hysterectomy was performed in 34.5% of patients. This study is novel because it is the first to shed light on secondary postpartum haemorrhage in unscarred uteri in Iraq. CONCLUSIONS: Endometritis was the most common cause of secondary postpartum haemorrhage, and emergency hysterectomy was the most common strategy of treatment.

Skin markers and the prediction of intraabdominal adhesion during second Cesarean delivery.

OBJECTIVES: The aim of the present study has been to examine skin scar characteristics and striae gravidarum, considering the reliability of each for predicting adhesions in repeat Caesarean sections. MATERIAL AND METHODS: A cross-sectional study was done over a period of two years. One hundred pregnant women were invited to participate in the study. Preoperatively, abdominal scar features (according to the scar's appearance) and stria gravidarum were both recorded.Then, at the time of surgery, intraabdominal adhesions were graded according to the modified Nair's classification. RESULTS: Among the skin markers, abdominal scar width (p = 0.001), depressed scar (p = 0.002) and striae colour grading (p = 0.0183) were found to have significant associations with intraabdominal adhesions; yet all were of low validity. CONCLUSIONS: Despite growing interest in the use of skin markers in the prediction of intraabdominal adhesions at the time of repeat CS, the present study demonstrates that these markers may not be reliable.