Delayed post-partum bleeding occurs in 1-2% of patients. It occurs most frequently between 8 and 14 days post-partum and in the majority of these cases it is due to sloughing of the placental site. However, if this bleeding is not self-limiting, further investigation will be required. Ultrasound examination of the uterine cavity will usually determine whether there is a significant amount of retained products although it can be at times difficult to distinguish between blood clot and retained placental tissue. Suction evacuation of the uterus is the treatment of choice and if this is required, it is imperative that antibiotic cover is given. If curettage is not required immediately to arrest bleeding, it is best to start antibiotics at least 12 h beforehand. This will reduce the risk of endometritis leading to uterine synechae. A combination of metronidazole and augmentin can be used in those patients who have endometritis without retained products of conception. In those that do have retained products who require curettage, intravenous antibiotics in the form of metronidazole and a cephalosporin or clindomycin are the antibiotics of choice. Great care must be taken at the time of curettage as the infected uterus is soft and easy to perforate. Rarely, these measures do not result in cessation of the bleeding and in life-threatening circumstances embolization of the uterine arteries may be effective in controlling the bleeding, as may the use of uterine tamponade using a Foley catheter balloon.
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The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.