Which of the following is the major cause for secondary PPH?

Appeared in: NHM MP Staff Nurse-2019

Explanation

Secondary Postpartum Hemorrhage (PPH) is defined as abnormal bleeding from the genital tract that occurs between 24 hours and 12 weeks after delivery.
The most common cause is retained bits of the placenta or membranes (retained products of conception).
These retained tissues prevent the uterus from contracting down properly (a state called subinvolution), leaving blood vessels at the placental site open.
Retained tissue can also become a focus for infection (endometritis), which further impairs uterine contraction and contributes to delayed bleeding.

Option B: Prolonged labor is a primary risk factor for uterine atony, which is the leading cause of primary PPH (bleeding within the first 24 hours), not secondary PPH.
Option C: Anaemia is a condition that makes a patient less able to tolerate blood loss; it is a potential consequence of hemorrhage, not a cause of it.
Option D: This option is incorrect because a major cause for secondary PPH is listed in the options.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Etiology of Secondary Postpartum Hemorrhage as background academic context rather than a clinical decision trigger.
A critical nursing responsibility after delivery is the careful inspection of the placenta and membranes to ensure they are complete. Any suspicion of missing fragments must be reported immediately.
Nurses must educate postpartum patients on the signs of secondary PPH before discharge, including the return of heavy, bright red bleeding, passing large clots, and foul-smelling lochia.
Postpartum assessment includes monitoring fundal height, uterine tone, and the characteristics of lochia. A boggy uterus, a fundal height that is not decreasing daily, or persistent rubra lochia can indicate subinvolution due to retained products.

How to Approach the Question

First, identify the key terms in the question: 'major cause' and 'secondary PPH'.
Recall the definition of secondary PPH: abnormal bleeding that occurs after 24 hours and up to 12 weeks postpartum. This time frame is crucial.
Evaluate each option in the context of this definition.
Analyze 'Retained bits of placenta'. Understand that this tissue interferes with the normal process of uterine involution (the uterus returning to its pre-pregnancy size) and can be a site for infection, both leading to delayed bleeding.
Analyze 'Prolonged labour'. Recognize this as a classic risk factor for uterine atony, the main cause of primary PPH (within 24 hours), not secondary.
Analyze 'Anaemia'. Identify this as a condition that worsens the outcome of bleeding but does not initiate it.

Concept Tested & Keywords

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E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur pp. 53-64, 65-80

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