Postpartum Bleeding Despite Uterine Contraction Medications

Experiencing bleeding despite taking uterotonics?

Hello Doctor: On August 5th, I underwent a dilation and curettage (D&C) procedure due to the absence of a heartbeat in my 14-week fetus.
My recovery went smoothly, and I had a normal menstrual period on September 11th that lasted for six days.
However, on September 25th, I experienced sudden and heavy bleeding, akin to turning on a faucet with no way to stop it.
I was urgently taken to the emergency room, where the doctor performed emergency hemostasis and scheduled a follow-up appointment with a specialist.

During the follow-up, the doctor suspected incomplete uterine involution and prescribed the hormone Diane and the uterotonic hemostatic agent Ergometrine.
During the course of treatment, there were days when I experienced no bleeding at all, while other times I would suddenly have bright red blood flow (around the second day of my expected period).
Is this normal? Should I expect to have no bleeding at all while taking the hemostatic medication? Or could it be that the uterotonic medication is ineffective? Thank you in advance for your response.

R, 20~29 year old female. Ask Date: 2019/10/02

Dr. Huang Jianzhong reply Obstetrics and Gynecology

On August 5th, I underwent induction of labor due to the absence of a heartbeat in my 14-week fetus.
Everything recovered smoothly.
On September 11th, I had a normal menstrual period that lasted six days.
However, on September 25th, I suddenly experienced heavy bleeding, resembling a faucet being turned on, and it wouldn't stop.
I was urgently taken to the emergency room where the doctor performed emergency hemostasis and scheduled an appointment with a specialist.
After the appointment, the doctor suspected incomplete uterine involution and prescribed the hormone Diane and the uterotonics Ergometrine for me to take.
During the course of taking these medications, there were times when I had no bleeding for an entire day, but then I would suddenly experience bright red bleeding (around the second day of my expected period).
Is this normal?
Answer: It is relatively normal.
Should taking hemostatic medication completely stop the bleeding?
Answer: Taking hemostatic medication does not guarantee that there will be no bleeding; it may reduce the bleeding, or the uterotonics may not be effective.

Answer: That is not the case.

Reply Date: 2019/10/02

More Info

Postpartum bleeding, especially after a procedure like a dilation and curettage (D&C) following a missed miscarriage, can be concerning and requires careful monitoring. In your case, it seems that you experienced a significant amount of bleeding weeks after your initial recovery, which led to an emergency visit. This situation can arise for several reasons, even when medications intended to promote uterine contraction and reduce bleeding are administered.

Firstly, it’s important to understand that postpartum bleeding can occur due to several factors, including retained products of conception, uterine atony (failure of the uterus to contract effectively), or even hormonal imbalances. In your case, the doctor suspected incomplete uterine involution, which means that the uterus may not have returned to its normal size and state after the pregnancy loss. This can lead to continued bleeding as the body attempts to expel any remaining tissue.

The medications you were prescribed, Diane (a hormonal contraceptive) and Ergometrine (a uterotonic agent), are commonly used to manage such situations. Ergometrine works by stimulating uterine contractions, which can help expel any retained tissue and reduce bleeding. However, it is not uncommon for patients to experience intermittent bleeding even while on these medications. The presence of bright red blood can indicate active bleeding, which may not necessarily mean that the medication is ineffective; rather, it could suggest that the underlying issue has not yet been fully resolved.

It is also essential to note that while these medications can significantly reduce bleeding, they do not guarantee that bleeding will stop entirely. Some patients may still experience episodes of bleeding, especially if there are fluctuations in hormone levels or if the uterus is still in the process of healing. The fact that you sometimes have days without bleeding followed by sudden episodes of bright red blood can be indicative of the uterus contracting and then relaxing, which may allow for some bleeding to occur.

If you are experiencing heavy bleeding again, or if the bleeding is accompanied by severe pain, fever, or other concerning symptoms, it is crucial to seek medical attention promptly. Your healthcare provider may want to perform additional evaluations, such as an ultrasound, to ensure that there are no retained products of conception or other complications.

In summary, while it is expected that medications like Ergometrine should help manage postpartum bleeding, it is not unusual for some bleeding to persist. Continuous monitoring and follow-up with your healthcare provider are essential to ensure that your recovery progresses smoothly. If you have any concerns about the effectiveness of your treatment or the nature of your bleeding, do not hesitate to reach out to your doctor for further evaluation and guidance. Your health and peace of mind are paramount, and your doctor can provide the best advice tailored to your specific situation.

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