WOMENS-HEALTH Messages for March, 1997: Re: excessive vaginal bleeding post d&c

Re: excessive vaginal bleeding post d&c

From: D. Ashley Hill, M.D. (anonymous@obgyn.net)
Thu, 27 Mar 1997 16:51:18 -0600 (CST)

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In reply to: lisa: "excessive vaginal bleeding post d&c"

At Thu, 27 Mar 1997, lisa wrote: An >ultrasound found the baby had stopped developing and a D&C was
>performed. Two weeks later I needed another one. I then began bleeding heavily and
>losing clots. (Feb. 27). Still something showed up on the ultrasound
>but my beta levels are going down however VERY slowly. March is almost over and I am still bleeding and at last
>count my beta levels were 56.

Lisa-

This is a tough question to answer without more, specific information (probably not amenable to the internet) but I agree that this seems unusual. There are 3 or 4 things that come to mind, in no particular order:

1. Retained placenta: This can cause a slowly falling beta-HCG. A D&C is a "blind" procedure, and in these cases a hysteroscopy, where a small, lighted tube is inserted into the uterus, can be extremely helpful to locate any left-over placenta.

2. Molar pregnancy: This is where the placental tissue behaves abnormally and grows even after a miscarriage or D&C. In unusual cases it can even metastasize, similar to a cancer, and require chemotherapy. Fortunately, it is highly treatable and does *not* prohibit future pregnancies. But, it needs to be diagnosed before it's treated, and a tissue sample, along with beta-HCG levels, is necessary. When a beta-HCG level does not fall despite 2 D&C's I would be quite worried about this diagnosis.

3. Infection: May cause bleeding, but not a persistent beta-HCG level.

4. Denuded endometrium: In this situation the D&C's have scraped off a lot of endometrium and the blood vessels are exposed. The leak a little at a time but it builds up to cause vaginal bleeding. Also does not lead to persistent beta-HCG levels.

Good luck with your situation. As always, I encourage discussing your issues with your doctor, and, if not satisfied, seeking a second opinion.

--
Ashley Hill
D. Ashley Hill, M.D.
Assistant Director, Department of Ob/Gyn
Florida Hospital Family Practice Residency
Orlando, FL
dahmd@gate.net

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