Postnatal vaginal bleeding problems and General Practice.

ABSTRACT

OBJECTIVES: to investigate women's experiences of problems with vaginal loss from 28 days to three months postnatally and to describe the treatment and referral patterns for women who consult their GP about such problems during the first three months postnatally. DESIGN: a longitudinal questionnaire study of consecutively delivered postnatal women and a report-card survey of GP consultations by women with problems with postnatal vaginal loss. SETTING: two health districts in the south of England. PARTICIPANTS: women delivering in the two health districts during specified recruitment periods in 1995 and 1996. For the GP study, with her consent, the GP returned an anonymous registration card for each woman presenting. FINDINGS: in the survey of women, 20% (64/325) reported problems with postnatal loss occurring between 28 days and three months after the birth. Around a half of these consulted a GP. The GP study was disappointing in that only 26% (30/115) of practices agreed to take part and 16% (18/115) returned notification cards. Forty-eight women were included from 18 practices. The most common presenting symptoms were excessive bleeding (29/48; 60%) and prolonged bleeding (26/48; 54%). The commonest form of treatment was antibiotics alone (15/48; 31%) but 12 women (25%) were neither treated nor referred. Referral (n=19) was for hospital admission, out-patient appointment or direct referral for an ultrasound scan. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE morbidity related to abnormalities of postnatal vaginal fluid loss (lochia) has been shown to be significant, yet nothing was known about the outcome of related GP consultations during the first three months postnatally. A variety of treatment and referral patterns were revealed, highlighting the need for a systematic review of the literature on the management of secondary postpartum haemorrhage. Health care workers need to be aware of the significant morbidity experienced by postnatal women in relation to their lochial loss.