{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T08:55:11Z","timestamp":1785488111568,"version":"3.56.0"},"reference-count":15,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,6,14]],"date-time":"2022-06-14T00:00:00Z","timestamp":1655164800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aust NZ J Obst Gynaeco"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Secondary postpartum haemorrhage (PPH) complicates ~1% of pregnancies and can cause serious maternal morbidity. However, evidence guiding optimal management is scarce and often based on case series and expert opinion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To measure the success of primary medical therapy in managing secondary PPH and to identify factors associated with need for surgical management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>Postpartum patients presenting to a tertiary women's hospital emergency department between July 2020 and October 2021 with secondary PPH were recruited. Data from the acute presentation were prospectively collected. Antenatal and intrapartum data were collected from medical record review. The primary outcome was the success of medical management for secondary PPH, defined by the implementation of medical or expectant measures without subsequent need for surgical intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One\u2010hundred and twenty patients underwent primary medical management for secondary PPH. Ninety\u2010eight (82%) were managed successfully with medical management and 22 (18%) required surgery. Medical management involved misoprostol (<jats:italic>n<\/jats:italic>\u00a0=\u200933; 27.5%), antibiotics (<jats:italic>n<\/jats:italic>\u00a0=\u2009108; 90%), and less commonly other uterotonics (<jats:italic>n<\/jats:italic>\u00a0=\u20096; 5%). Factors associated with lower rates of successful medical management included: antecedent manual removal of placenta (MROP) (odds ratio (OR) 0.2, <jats:italic>P<\/jats:italic>\u00a0=\u20090.047), primary PPH \u2265500\u2009mL (OR 0.39, <jats:italic>P<\/jats:italic>\u00a0=\u20090.048) or \u22651\u2009L (OR 0.24, <jats:italic>P<\/jats:italic>\u00a0=\u20090.009), &gt;200\u2009mL blood loss at presentation (OR 0.17, <jats:italic>P<\/jats:italic>\u00a0=\u20090.015), increasing time post\u2010delivery (OR 0.84, <jats:italic>P<\/jats:italic>\u00a0=\u20090.044), retained products of conception (RPOC) on ultrasound (OR 0.024, <jats:italic>P<\/jats:italic>\u00a0=\u20090.001) and vaginal birth (OR 0.27, <jats:italic>P<\/jats:italic>\u00a0=\u20090.027).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Medical management was highly successful. Vaginal birth, MROP, primary PPH, RPOC on ultrasound and increasing time post\u2010delivery were associated with increased need for surgical management.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ajo.13552","type":"journal-article","created":{"date-parts":[[2022,6,14]],"date-time":"2022-06-14T09:54:33Z","timestamp":1655200473000},"page":"52-58","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Medical management of secondary postpartum haemorrhage: A prospective cohort study"],"prefix":"10.1111","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3434-5870","authenticated-orcid":false,"given":"Rachael","family":"Fox","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology Mercy Hospital for Women  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Mercy Hospital for Women  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0938-1802","authenticated-orcid":false,"given":"Nicole","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Mercy Hospital for Women  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Davis","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Northeast Health  Wangaratta Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Cvejic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, School of Public Health University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5742-9148","authenticated-orcid":false,"given":"Samantha S.","family":"Mooney","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Mercy Hospital for Women  Melbourne Victoria Australia"},{"name":"Department of Obstetrics and Gynaecology University of Melbourne  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,6,14]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD002867"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0306-5456(01)00230-3"},{"key":"e_1_2_7_4_1","first-page":"e106","article-title":"Prevention and management of postpartum haemorrhage","volume":"124","author":"Mavrides 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