Surgical versus medical treatment for secondary post-partum hemorrhage

Background. Secondary post-partum hemorrhage (PPH) is defined as any abnormal bleeding from the birth canal occurring between 24 hours and 12 weeks postnatally. Treatment usually falls into one of the two categories: surgical evacuation of the uterus or medical treatment. Objective. To compare the two different clinical approaches and the implications on future fertility. Study design. A retrospective study. Setting. From 1990 to 2002, 168 women diagnosed with late PPH were admitted to the Hadassah Medical Centers in Jerusalem. The cases were divided into two groups according to the planned initial treatment: primary surgical treatment vs. primary medical treatment. Results. Primary surgical treatment was associated with significantly more primary negative events (p=0.01). After the primary event, primary surgical treatment was associated with fewer future deliveries (p=0.04) and resulted in increased rate of secondary infertility of borderline significance (p=0.06). Conclusions. Our results show that secondary PPH is related to high rates of immediate and long-term complications. It is possible that a conservative medical approach for secondary PPH may be superior to surgical treatment.