PREGNANCY-BIRTH Messages for December, 1999: Sub-involution at 2 weeks postpartum

Sub-involution at 2 weeks postpartum

From: Anne

anonymous@obgyn.net

Mon, 6 Dec 1999 23:10:52 -0600 (CST)

I am a 29 year old who recently gave birth (oct 28,1999) and had a very unusual occurence of postpartum hemorrhage which I wanted to share with you for future reference.

I had an uncomplicated vaginal delivery, and no unusual bleeding or other symptoms immediately postpartum. I had been back at home for 2 weeks when one night I woke up with a slight cramping sensation, which was very similar to a mild menstrual cramp. I got out of bed, figuring that moving around might alleviate the discomfort. Without warning, massive amounts of bright red blood and very large clots (ranging in size from golf-ball to nearly tennis-ball size) gushed from my vagina. The bleeding continued, and when I saw it was not going to stop, we called 911.

Besides the bleeding, I began to experience symptoms of hypovolemic shock. There was no pain involved as far as cramping goes, just massive amounts of bleeding. I ended up requiring a transfusion of 4 pints of blood, and a D and C was performed. The D and C did stop the hemhorrage, and I was ready to return home the same evening.

The initial diagnosis (before the pathology report was completed) was "retained placenta/conception products". Not until my follow up visit with my regular obstretician was the diagnosis known. Sub-involution was the diagnosis, caused by a clot implanting in the myometrium...I was told this is really, really rare.

The reason I am telling you this story is that women who deliver a child should be better educated on postpartum issues, since the hospital personnel told me that many women die of delayed postpartum hemhorrage since they do not realize anything is wrong, or delay getting medical attention. I (and my physician) suspect that the abnormality in my uterine lining might be a result of my past gynecological history--5 previous D & C's to remove the products of spontaneous abortion (miscarriages), two D & E procedures performed as elective abortions (all before the first 12 weeks) and a history of endometriosis.

Since so little is known about this condition, I wonder if it could recur were I to have another child? This is strictly a question to satisfy my scientific curiousity, and is hypothetical, since I have elected to have a tubal ligation...

I hope this information is useful to someone out there, if you have an answer to my question or can provide further information on sub-involution, please feel free to e-mail me with comments/questions. Thank you for your attention to this posting.

-- Anne

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