Postpartum Bleeding: Retained Membranes and Treatment Options

Q: Postpartum Bleeding: Retained Membranes and Treatment Options

Hello： There are many causes of postpartum hemorrhage, including incomplete uterine involution, poor uterine contraction, infection, maternal health issues, coagulopathy, and abnormalities related to the placenta. <br>Retained membranes can also be a potential cause, and there ar

After delivery, the membranes were cleared, but there is still persistent bleeding?

Hello, I gave birth naturally on April 12, and I have been experiencing continuous bleeding for 8 weeks.
On June 6, I underwent a hysteroscopy and dilation procedure, during which the doctor informed me that the fetal membranes were cleared.
After taking medication, I was told that the bleeding should stop within three days, but during my follow-up visit, the doctor mentioned that the bleeding was due to incomplete uterine recovery and that I needed to take more medication to stop the bleeding.
They also performed cervical dilation to facilitate the expulsion of blood.
I would like to ask why the fetal membranes might remain.
The doctor's explanation was that they adhered to the upper part and would not be specifically cleaned during delivery, allowing them to detach naturally.
Is this explanation reasonable? Does this constitute a medical oversight? Additionally, I would like to know what potential long-term effects I might face.
If the current bleeding situation does not improve with medication, what treatment options should I consider? Thank you for taking the time to respond.

evo, 30~39 year old female. Ask Date: 2014/06/12

Dr. Dong Yuhong reply Obstetrics and Gynecology

Hello: There are many causes of postpartum hemorrhage, including incomplete uterine involution, poor uterine contraction, infection, maternal health issues, coagulopathy, and abnormalities related to the placenta.
Retained membranes can also be a potential cause, and there are instances where postpartum women consume supplements like ginseng or herbal soups that may lead to bleeding.
A small amount of retained membranes may resolve on its own and may not always be detectable through ultrasound or other examinations.
Therefore, if there is abnormal bleeding postpartum, it is important to seek medical attention promptly.
In cases of difficult treatment, such as poor response to treatment or persistent heavy bleeding, it is advisable to seek help from a medical center.
Thank you~~

Reply Date: 2014/06/12

More Info

Postpartum bleeding, particularly when it persists beyond the expected timeframe, can be a concerning issue for new mothers. In your case, it seems that you are experiencing prolonged bleeding eight weeks after a natural delivery, which has led to medical interventions such as a hysteroscopy and medication to manage the situation.
Retained membranes, or retained placental tissue, can occur for several reasons. During delivery, if the placenta does not detach completely from the uterine wall, fragments may remain. This can happen if the placenta is adherent or if it is not thoroughly examined after delivery. In some cases, the membranes may be located in areas that are not easily accessible or visible during the delivery process, leading to their retention. Your doctor’s explanation that the membranes may have been left undisturbed to allow for natural detachment is a common practice, but it can sometimes lead to complications if the membranes do not detach as expected.

Regarding whether this situation constitutes medical negligence, it is essential to consider the standard of care provided during your delivery. If the medical team followed established protocols and guidelines, it may not be classified as negligence. However, if there was a failure to adequately assess the placenta after delivery or if there were clear signs of retained tissue that were overlooked, it could warrant further investigation. It may be beneficial to seek a second opinion from another healthcare provider or a maternal-fetal medicine specialist to discuss your concerns and the care you received.

As for potential long-term effects, retained membranes can lead to complications such as infection (endometritis), heavy bleeding, or even the need for further surgical intervention if the tissue does not resolve with medication. It is crucial to monitor your symptoms closely. If you continue to experience bleeding that does not improve with medication, or if you develop symptoms such as fever, severe pain, or foul-smelling discharge, you should seek immediate medical attention.

In terms of treatment options, if medication is not effective in stopping the bleeding, further surgical intervention may be necessary. This could include a repeat hysteroscopy to remove any remaining tissue or, in more severe cases, a dilation and curettage (D&C) procedure. Your healthcare provider will be able to guide you on the best course of action based on your specific situation.

In the meantime, it is essential to take care of yourself. Ensure you are well-hydrated, maintain a balanced diet, and rest as much as possible. Monitoring your bleeding and any accompanying symptoms will be crucial in managing your recovery. Regular follow-up appointments with your healthcare provider will help ensure that you are healing properly and that any complications are addressed promptly.

In summary, retained membranes can lead to prolonged postpartum bleeding, and while your doctor’s explanation is reasonable, it is essential to evaluate the care you received. If your symptoms persist despite treatment, further intervention may be necessary. Always feel empowered to seek a second opinion if you have concerns about your care.

Similar Q&A

Understanding Postpartum Hemorrhage: Risks and Recovery After D&C

I underwent a dilation and curettage (D&C) procedure seven weeks postpartum. The membranes were removed, but I still experienced bleeding for a week after taking medication. My doctor informed me that the membranes were located at the top, so they were not specifically cleare...

Dr. Dong Yuhong reply Obstetrics and Gynecology
Hello: If you experience bleeding after a dilation and curettage (D&C), you can return for a follow-up appointment. Typically, your attending physician will schedule a follow-up visit for you, but if you haven't reached your appointment time, you can also come in earlier...

Understanding Postpartum Complications: When to Worry About Bleeding

I gave birth a month ago, but I have been experiencing continuous lochia without interruption. For the past two days, I have felt slight abdominal pain, so I went to the hospital for an examination. The doctor said there is still blood and fluid in my uterus and prescribed uterin...

Dr. Wang Hanzhou reply Obstetrics and Gynecology
Persistent postpartum lochia should be addressed immediately if there is a significant retention of placental or membrane tissue. Please maintain close communication with your physician; the bleeding is not related to the tubal ligation.

Post-Miscarriage Bleeding: Understanding Recovery and Next Steps

I would like to ask about a sudden increase in bleeding on February 2nd, which was accompanied by blood clots. I visited an obstetrician-gynecologist on February 3rd, and the doctor diagnosed a miscarriage. Due to the continuous bleeding, I underwent a minor surgical procedure. A...

Dr. Zhang Kunmin reply Obstetrics and Gynecology
Hello, the factors affecting intermenstrual bleeding are numerous. After a miscarriage or childbirth, it is common to experience irregularities for some time. Other causes include age, environment, lifestyle, stress, emotional instability, weight changes, medications, emergency c...

Addressing Postpartum Stitch Issues: Solutions for Pain and Bleeding

Hello, during the delivery of my second child, the doctor slightly stitched higher up on the vaginal canal. It has been five years since I gave birth, but now whenever I have sexual intercourse with my husband, it irritates the scar and causes bleeding. What can I do to improve t...

Dr. Lü Lizheng reply Obstetrics and Gynecology
Hello! It's better to come to the hospital for an examination. Sometimes it may just be inflammation. If necessary, we can certainly perform the suturing again. Sincerely, Dr. Lu Li-Cheng, Director of the Department of Obstetrics and Gynecology, Taoyuan Hospital, Ministry of...