Question about PPH nearly 5 days after birth

[pjabslenz]

A friend shared a story with me of a birth were her neighbor delivered her baby, was discharged but had passed some large clots in the days following her delivery. The clots were excessive so she returned to the hospital on 2 different occasions but was told to go home because she was fine. Well, she earned herself a ride in an ambulance & a couple days in the hospital, only after passing out at home. It was determined she had a post pardum hemmorage possibly due to a retained placenta. I say possibly because she has since been sent home with a scheduled appointment next week for an ultrasound to determine if she is retaining some placenta. :

Out of pure curiousity I'd like to know:

* What factors(over doing it, not resting, etc) could contribute to PPH days after a birth?

* Is it common for hospitals to wait days to a week to check for retained placenta?

* If placenta is retained, is it likely she could hemmorage again?

* What other risks are involved(hemmorage, infection, etc)?

This just doesn't seem like it's a safe thing for the doctor to wait because of scheduling conflicts. I'm having trouble understanding this one.

[RaRa7]

:

[Jenlaana]

I'm not a professional, but after my last birth I did not stay in bed long enough (against the advice of my medical 'person') and had some bleeding issues. I don't know about retained placenta, but I definitely know that moving around too early can cause excessive bleeding. This time I'm following advice and not getting out of bed for at LEAST 3 days, and then not doing much of anything for the first week (that was the advice that I thought I didnt need to listen to last time )

[courtenay_e]

Although, as a birth professional, my first question would be (because of the treatment she seems to be getting) whether or not she's a medicaid patient.

HOWEVER, then my next comment would be that I called my midwife/OBs office TEN DAYS post partum when I was definately bleeding out...I'm talking filling a BLUE pad in fifteen minutes, and told them that--forget a "period" pad in an hour!! They gave me over to the nurse practitioner, who told me in a TOTALLY annoyed and bored voice (even though I said that it was my second, that I knew what regular lochia should be like--etc, etc.) that "WOMEN B-L-E-E-D after they have a baby, ma'am! Just lie down for an hour, drink a liter of water, and let me know when it has slowed down." after which she hung up the phone. THEN, five minutes later, my MOTHER called the office and told them that it looked like a murder scene in my home, and that if she didn't speak to an OB or midwife immediately, we'd be calling an ambulance and THEN filing a complaint with the medical board. Well, they had a trauma team waiting for me, and good thing... because wonder of wonders, I knew what I was talking about!

Point is, the medical establishment doesn't always understand that women actually pay attention to what is going on in their own body.

On one hand, perhaps she was doing too much, and with forced rest (ie: being in bed in the hospital), it slowed down. Perhaps (PERHAPS) because of this they're not sure whether the bleeding is from exhaustion or from placenta or from other reasons. And, from personal experience, if they don't HAVE to do a D&C, it might be better for her chances of having more children if they DON'T. So...hopefully they're being wise and watchful over full of hubris.

Oh, and. Yes, actually, you can bleed out for up to ten days to two weeks after birth, and because of clotting disorders, retained placenta, or maternal exhaustion. I know that some of these "causes" would have different rangesin which we'd expect the bleeding to take place, though.

[mendomidwife]

If she were my patient, I would want to see her - check her uterus for firmness, size and any tenderness. Check her temperature. Check her lochia - bright red? foul odor? With infection the lochia looks like tomato soup..thicker and smells bad. I might also check her hemoglobin, although it might be low from the birth - but I wouldn't want it to be extremely low. If I didn't think there was an infection needing treatment, I would put her on a course of oral Methergine for 2 or 3 days. That might dislodge any microscopic pieces of placenta that are causing subinvolution.
Nursing, fluids, rest, nutrition, herbs to promote involution.....all important too...

Carla

[birthdancedoula]

Originally Posted by pjabslenz

Out of pure curiousity I'd like to know:

* What factors(over doing it, not resting, etc) could contribute to PPH days after a birth?
Certainly not taking it easy in the days following birth can lead to a situation of late PPH if the mom is already at risk for PPH. Risk factors include the birth of a large baby, uterine atony, previous PPH, and long, dysfunctional labor. I'm sure there are a few others as well.

* Is it common for hospitals to wait days to a week to check for retained placenta?
Seems completely opposite of the standard of care to me.

* If placenta is retained, is it likely she could hemmorage again?
A mom is likely to continue bleeding with retianed placenta because the uterus cannot completely involute back into the pelvis the way it needs to. The placental attachment site will continue to bleed if the blood vessels are not cut off, which happens when the uterus contracts after birth. Large clotsas well as retained placenta can hinder the uterus from doing its job of involution.

* What other risks are involved(hemmorage, infection, etc)?
Yes on both accounts. The mom's risk for uterine infection goes up a lot the longer tissue fragments remained retained. Not to mention low milk supply caused by retained placenta.

This just doesn't seem like it's a safe thing for the doctor to wait because of scheduling conflicts. I'm having trouble understanding this one.

You are right...it is not safe. This mom needs to go to an ER and get treated immediately.

I had a late PPH at 8 days PP. I came home with my 2 toddlers and nb one afternoon and noticed a puddle on my car seat. When I looked down and saw red I began to feel woozy. I called my mw, who was on her way to do my home visit, and she said to get to the hospital. I called a CNM I worked with and asked her to meet me at the hospital. She had me take my temp and bp...which were extremely high and low respectively. Minutes later I passed out. My dh's mom called an ambulance and took me to the ER. It turned out that I had retained clots and placental tissue and I was brewing a nasty infection. I had a D&C and a course of antibiotics and was fine. The only thing that sucked (besides being in the hospital period) was that I got grief for having a HB.

[pjabslenz]

Thanks for the information. As for what care...it's not medicaid, she received her care in a military hospital.

[courtenay_e]

Ah. even better...

[pjabslenz]

As it turns out, the ultrasound revealed retained placenta. All I know as of now is that her doctor has recommended a wait and watch. She's also been informed that she may possibly need a hysterectomy if the placenta doesn't dislodge.: I'm not sure what coures of action this person is taking but I'm praying she's seeking a second opinion and being proactive about her health.

[Molitor194]

Don't mean to hijack this thread, but I do have a question of my own and I am not sure if it's appropriate to start a new topic.

I too had some sort of PPH episode about 5 days after birth, only that this was after an emergency c/s (fetal distress)

Basically it was midnight, had just finished nursing my little one, and all of the sudden I felt a gush and some lightheadedness. I looked down and it was blood coming down my legs quite fast. I had been told on discharge instructions that soaking one pad in 30 minutes warranted a trip to the ER. Well... mine was a pad in 15 seconds and blood all over my carpet and bathroom floor. Like described in a post above, it looked like someone had been stabbed in my bathroom. I do know that blood on sight looks like more than it is in actual volume but I ended up taking an ambulance drive.

At the ER, they did a blood test (didn't tell me the results) and did an ultrasound (they had to catherize me because hospital policy said that since I came in emergency I was not allowed to just drink water!). I was given no official explanation except to just rest more. My OB never bothered calling back the hospital or ever checking up on me, and when I came back to get my staples taken out they just said "well if the ER discharged you, then you're fine". The ER staff basically looked annoyed at us, and several times mentioned "didn't they tell you that people bleed after birth?" My mom who had 3 sections was distraught by the episode and said she never bled like that or seen something like it.

Is there anything that can be said from that experience? I am expecting #2 in March, it will be over 4 years since my first birth, and I am really hoping for a vbac. Of course that episode really scared all of us and it's a bit in the back of my mind. It took me many months to get over my birth, especially how it ended in a c/s, and would like to know if this is something that I should expect/be aware of after this birth as well.

Thank you so much!

Victoria