Retained Placental Fragments and Hemorrhage After Childbirth

Five days after giving birth naturally to my daughter, I took her to a follow up appointment with our doctor. When I reached the office and got out of the car, I experienced a vaginal hemorrhaged. The bleeding stopped within a half an hour and after thorough examination, the doctor sent me home concluding that a bruise or hematoma in my vagina bled heavily, the blood pooled while I drove in the car and gushed out when I stood. However, the next day, I began to hemorrhage again and this time, it did not stop. Instead, it got heavier. I spent the night in the emergency room and an ultrasound found placental fragments in my uterus. I underwent a D&C (dilation and curettage) to remove the fragments and control the bleeding.

What are placentas and placental fragments?
The placenta is an extremely important element in maternity as it connects the baby to the mother's uterus. The placenta is embedded in the uterus and forms the umbilical chord, which provides oxygenated blood and nutrients to the baby and removes deoxygenated blood from the baby. After giving birth, the mother will typically deliver the placenta. Sometimes, pieces of the placenta break off and stay attached to the uterus. These pieces are referred to as placental fragments. Retained placental fragments is one of the most common causes of postpartum hemorrhage. When pieces remain in the uterus, the uterus cannot contract properly and open blood vessels continue to bleed instead of healing.

How do you know if you have retained placental fragments?
The most typical sign of retained placental fragments is heavy vaginal bleeding. But, women may also start a fever and their uterus may be sore. The symptoms may not be evident immediately following child birth. Signs may appear days after giving birth, or even weeks. In terms of hemorrhaging, the blood will be bright red. It can occur as a constant, low flow or as large gushes. A doctor can examine the fundal height of a woman's uterus and if it is higher than normal, it may indicate that there are retained placental fragments and blood clots inside the uterus. Also, an ultrasound can detect the presence of clots and placental fragments in the uterus.

How is it treated?
Women will be given intravenous fluids to help keep them stable during and after the blood loss. Typically, a D&C is conducted to scrape the retained fragments from the uterus. A D&C is a surgical procedure that require anesthesia. After the D&C, the doctor will prescribe an oxytocic medication. These drugs stimulate contractions in the uterus, helping the uterus heal. Sometimes, a doctor will try an intravenous oxytocic drug before a D&C to contract the uterus and force it to expel the fragments.

The intent of this article is not to add an element of fear to childbirth. This type of secondary postpartum hemorrhage occurs in less that 1% of births. And, just because a woman experienced this once, does not mean that it will happen again in a subsequent pregnancy. However, it is important for women to be aware of this possibility and know the symptoms in case they suspect they are experiencing these complications.

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http://www.thefreedictionary.com/oxytocic

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http://www.babycentre.co.uk/pregnancy/labourandbirth/labourcomplications/retainedplacenta/