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What is Which One of the following is NOT a cause of Secondary Postpartum Haemorrhage? and explain in detail?
(A) Placenta previa[?]Secondary Postpartum Haemorrhage: The bleeding usually occurs between 8th to 14th day of delivery.The causes of late postpartum hemorrhage are:Retained bits of cotyledon or membranes (most common).Infection & separation of slough over a deep cervicovaginal laceration.Endometritis & subinvolution of the placental site--due to delayed healing process.Secondary hemorrhage from cesarean section wound usually occur between 10-14 days.-It is probably due to--(a) separation of slough exposing a bleeding vessel or (b) from granulation tissue.Withdrawal bleeding following estrogen therapy for suppression of lactation.Other rare causes are: Chorion-epithelioma occurs usually beyond 4 weeks of delivery; carcinoma cervix; placental polyp; infected fibroid or fibroid polyp and puerperal inversion of uterus.[?]Postpartum Haemorrhage (PPH): 15-30 min. after delivery, the uterus contracts to expel placenta from the deciduaUteroplacental spiral arteries thrombose (involution) as the myometrium continues contract1deg; atony of the uterus causes uteroplacental spiral arteries to partially thromboes. 2deg; subinvolution occurs due to placenta retention +- infection.Causes of secondary Postpartum Haemorrhage are:Retained bits of placenta; Postpartum infection; Infection of Cervical and Vaginal TearsPuerperal Inversion of Uterus; Uterine Polyp or Fibroid; Undiagnosed carcinoma of cervix; Chorion-epitheliomaRisk Factor Identified by Previous StudiesObstetrics HistoryCurrent PregnancyLabour complications*. Prior PPH*. Nulliparity clot*. History of retained placentaNon-obstetric factors*. Integrated bleeding disorder*. Age under 20 or over 40*. Anticoagulant therapy*. Fetal macrosomia*. Stillbirth*. Induction of labour*. Antepartum hemorrhage*. Chorioamnionitis*. Epidural anaesthetic*. Placenta accreta*. Multiple pregnancy*. Preedampsia*. HELLP syndrome*. Polyhydramnios*. Peterm birth*. Prolonged labour*. Prolonged third state*. Prlonged second stage*. Failure to progress*. Augmented labour*. Genital tract trauma*. Lacerations*. Episiotomy*. Retained placenta*. Mode of delivery*. Cesarean section*. Forceps*. Ventouse SUGGESTED CAUSESPosition of Placenta*. Placenta acereta*. Placenta praevia Genital tract trauma Spontaneous*. Uterine rupture*. Genital tract*. Lacerations Iatrogenic*. Episiotomy*. Caseseran delivery*. Ventous*. Forceps Retained placenta & ClotsUterine atony Labour-related*. Induction of labour*. Oxytocin use*. Chorioamnionitis*. Precipitous labour*. Prolonged labourOverdistension*. Multiple pregnancies*. Fetal macrosomia*. Polyhydramnios*. Placental abruption with large intrauterine dot*. Anaesthesia*. General anaesthesia with inhaled agentsCoagulation disordersThrombocytopeniaAnticoagulant therapyInherited bleedingdisorderDisseminatedIntravascularCoagulopathy*. Liver dysfunction*. Intrauter ne fetal demise*. Amniotic fluid embolism I*. Placental abruption Uterine inversionPostpartum HaemorrhageConsequencesMental mortality: The leading cause of maternal death worldwideMaternal morbidityCoagulopathy: After deliveryRespiratory failure; With an increased need for mechanical ventilationRenal failure: Resulting from hypoperfusionOther morbidity: Sepsis, Hysterectomy, Prolonged length of hospital stayCAUSES OF PRIMARY & SECONDARY POSTPARTUM HEMORRHAGEPrimary (early)Secondary (late)Uterine atony: Labor-related; Anaesthesia*. Over distension of uterusPelvic trauma: Iatrogenic; Spontaneous Retained products of conception: Coagulopathy: DIC; Thrombocytopenia, Inherited disorders Uterine inversion Abnormal placentation:*. Placenta previa; Placenta accreteAbnormal placentation*. Subinvolution of placental site*. Placenta accretaRetained production of conception*. Infection: Endometritis*. Infection of cesarean section scarCoagulopathyUterine pathology*. Fibroids, Cervical cancer PRIMARY PPH: CAUSESFour TsSpecific CauseRelative FrequencyToneAtonic uterus70%TraumaLacerations, hematomas, inversion, rupture20%TissueRetained tissue, invasive placenta10%ThrombinCoagulopathies1%