Thursday, September 21, 2006

Placental Scab?

I have been meeting regularly with my clients whose baby was stillborn. The last time we met, I asked about the mother's bleeding. She said it had slowed down a lot and then she had a burst of red blood and heavier flow at day 11. The mother of a friend told her that was to be expected because the scab where the placenta was comes off around day 10 or 11.

I have never heard if a placental scab. Nor of its release triggering postpartum bleeding a week and a half post partum.

If anyone can enlighten me on this subject, please do.

My reaction is that it sounds plausible, but not exactly as my client relayed it. It makes sense that the body would make a covering for the raw area where the placenta attached to the uterus. After all, that is a lot of surface area to leave open to infection otherwise. But the scabs I'm used to thinking of are hard and inflexible. They would not do the job on a uterus that is shrinking in the days postpartum. And it seems that one would notice scabby tissue leaving the uterus more than clots and lochia. I certainly don't recall seeing scabs when I wiped.

So perhaps a scab in function, but with a different design. Something softer and more dynamic. More like a big clot. In fact, what about exactly like a big clot? I can't remember my postpartum bleeding well enough to recall whether I passed more clots roughly 10 days after delivery or if my bleeding increased.

I like the idea of it anyway. Another example of our bodies taking care of and protecting themselves.

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Anonymous Maica Preoteasa said...

Yes, I have heard of that and experienced a similar thing with both of my pregnancies. After my full-term singleton pregnancy, I had a marked increase in flow about 10 days postpartum. After my Twin-to-Twin-Transfusion-Syndrome pregnancy (35w6d) with one child very tragically stillborn, my flow exactly 10 days postpartum was apocalyptic. Needed methergen and just barely outran getting transfused. I only mention these details because my increase in flow was very different with the stillbirth pregnancy, despite the fact that there was a survivor -- of course the size of identical twins' placenta is bigger than a singleton's. But, I am wondering if stillbirth affects this postpartum "burst," as you so accurately put it. I wonder if the "disused" part of the placenta (so to speak) from the time of the fetal demise until birth affects the uterine surface in some way which influences how much we bleed. Food for thought.

11:55 AM  
Blogger mm said...

I, and most of people I know willing to discuss post partum issues have all experienced this too. Except with my c/s in which I had next to no bleeding at all. I believe that maica preoteasa is on the right track with the effects of the loss on the placenta and uterine wall. I'm thoroughly curious now and plan on asking the pathologist friend if they have anything to support that idea.
Interesting thoughts. This is the impetus to get me to work on unpacking my books. I was given a midwifery textbook for my birthday, maybe I can find something in there... ugh I hate unpacking the books!

12:37 PM  
Blogger doulicia said...

maica -- First I am sad to hear about the loss of your baby. Twin-to-twin transfusion syndrome is so helplessly sad.

As to the point you raise about babies that die in utero and the subsequent bleeding, it IS good food for thought.

k, let me know if you learn anything from your books. It could well be that this has never been researched.

7:55 AM  
Blogger emjaybee said...

Wow. I had terrible, call-the-ambulance passing out bleeding 10 days pp too! I thought I was hemorrhaging or had retained placenta...though they couldn't find anything on ultrasound, and I had had a c/sec. I just assumed I had passed whatever I'd retained before the ambulance came. How odd that it might be something else.

I will tell you, I was examined by three OBs, and my midwives, and all they could come up with was possible retained tissue, that I had been on my feet *too much*, or that I had been OFF my feet too much. Clearly there's a serious knowledge gap.

I had heavy bright red bleeding all the way up to six weeks, and then it shut off like a switch was flipped...nothing. None of the baby books prepared me for that...for six weeks I kept wondering if I would hemorrhage again and die this time. Terrifying.

9:37 PM  
Blogger Lucina said...

The "scab" is called an eschar. I think that's part of why the lochia changes from red to yellow or white-ish. There's an explanation of the late bleeding with the release of the eschar here, but I also see it as a consequence of the sudden increase in activity that many women have when their energy increases 10 days or so pp.

1:01 AM  
Blogger Lucina said...

Hrm. As I'm looking at my comment, that link doesn't show up in its entirety. Let me try again. I'll break it up into bits.

1:03 AM  

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