Postpartum Uterine Atony: Symptoms, Causes, and Treatment

Question
I am  71/2 weeks post partum.  At my 6 week pp visit I was still bleeding and my cervix was still dialated and my uterus was not as small as it should have been.  I was given methergine.  At my follow up visit this week I was still bleeding, my cervix was a tad smaller, but uterus was still enlarged. I had some blood work done and my HCG levels were at 84.  My midwife believes that there could could be placental remains (my placenta had to be removed by an OB pushing on my stomach and pushing it out).  My  bleeding is not very heavy, and in fact today it has almost stopped today.  My white cell count was good.  My midwife is thinking that I'll have to have a D&C this week.  I am fearful of this because I had to have a D&C last Oct (late miscarriage) and had severe heemorage.  Since my bleeding seems to be stopping, do you think a D&C would still be necessary?

Answer
Dear Melissa,

Unfortunately, all signs suggest placental pieces are likely to still remain in your uterus. They may do an ultrasound to confirm this before doing a D&C, but with the symptomology, I'm not sure how cost effective that is. If small fragments of placenta or membrane are retained, this definitely can cause heavy bleeding and infection later on. Heavy bleeding which happens from 24 hours up until six weeks after the birth is known as secondary primary postpartum hemorrhage (PPH) and happens in about 1% of deliveries. It really is likely to be in your best interests to have the D&C done and be rid of this problem. Having a history of the hemorrhage with the previous D&C does not necessarily mean you will have the same thing occur again. I would suspect your uterus is quite inflamed right now, thus the enlargement) and is in a "slow bleed" state anyway. I would not count on the bleeding being gone for good. It may have slowed a bit, but retained pieces of placenta tend to continue to cause problems until removed.

I hope this has helped you and answered your question. I wish you well.

Brenda