1. Infection and retained products co-exist.
2. Under-estimation of hemorrhage is very common as compared to primary PPH, secondary PPH invariably happens at home. and waiting that bleeding will settle on its own is very common.
3. When should women think that they are having secondary PPH. If she is channging vaginal sanitary towels every hour, that menas she has significant hemorrhage. Generally feeling unwell and feeling faint and shivery are other indicators.
4.One common reason for secondary PPH is clot retention. This commonly occurs in women who undergo elective cesarean and have never laboured before. Eventhough one may have completley cleaned the uterine cavity during cesarean, taking all the placental and membranous tissues stiil there's a possibility that she may hemorrhage and collect the clot in the uterine cavity and later present as Secondary PPH. This bring s the argument for cervical dilatation during elective cesarean in women who are not in albour and also to warn them before.
5.The other thing to think about is putting a little dilator or a plastic cannula inside the cervix for few days for the bllod to seep out.
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