Department of Obstetrics and Gynecology, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq.
Department of Obstetrics and Gynecology, College of Medicine, Al-Anbar University, Al-Anbar, Iraq.
Ginekol Pol. 2020;91(10):607-612. doi: 10.5603/GP.a2020.0095.
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.
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.
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.
Endometritis was the most common cause of secondary postpartum haemorrhage, and emergency hysterectomy was the most common strategy of treatment.
产后出血（PPH）是分娩的严重并发症，是一种危及生命的情况，可能导致育龄妇女不孕。本研究的目的是强调产后出血的潜在原因和阴道分娩患者的结局，以降低孕产妇死亡率和发病率。
这是在伊拉克巴格达 AL-Yarmouk 教学医院妇产科进行的前瞻性队列研究。该研究在 2015 年 12 月至 2018 年 12 月期间进行了 3 年。符合以下条件的女性纳入研究：经阴道分娩，孕周至少 24 周，无既往剖宫产或子宫瘢痕，产后 24 小时内出现生殖道出血，产后 6 周内就诊，接受复苏措施和药物治疗，并观察其对药物治疗的反应以及是否需要手术干预。评估管理类型，并收集和记录需要清除残留胎盘组织或子宫切除术的患者的组织病理学检查结果。
分析了 200 例病例；严重产后出血的发生率为每 10000 例分娩 60 例。子宫内膜炎是主要原因（64%的患者），其次是胎盘残留（13.5%）；34.5%的患者行急症子宫切除术。本研究是新颖的，因为它首次阐明了伊拉克未瘢痕子宫的继发性产后出血。
子宫内膜炎是产后出血的最常见原因，急症子宫切除术是最常见的治疗策略。
