Karleen asks for input to advise the mother of a 21 month old breastfeeding
child. The mother has an entirely normal obstetric history.  From Karleen's
post:

"I am also 7 1/2 weeks pregnant (yay) and had an appointment today with the
Obstetritian. He did an ultrasound and found an partial placental abruption
(2 cm) and told me I have to wean my son."

There is *no* indication for performing an ultrasound at this stage of
pregnancy in the absence of symptoms or signs of pathology.  A history of
early miscarriage might be an indication.  Significant vaginal bleeding
would be too, as some placental abruptions are accompanied by bleeding; some
are not, if the abruption is behind the center of the placenta, away from
placental borders.  Abruption even in late pregnancy is not that easy to
diagnose with ultrasound, and to pick it up at 7 weeks you would have to be
a real ace at such diagnostics,something I doubt is the case with this
clinician, read on.   A placental abruption is a potentially
life-threatening complication for the mother as well as the fetus and I am
having difficulty understanding how the obstetrician could allow a woman who
lives in a geographically isolated place to simply return home with such a
diagnosis, with vaginal progesterone (have never heard of using that, in
fact), something to stop cramping, and instructions to wean her son.  The
drugs commonly used to 'stop cramping' are non-steroidal anti-prostaglandin
drugs, which significantly INCREASE the risk of spontaneous abortion if
taken in early pregnancy and which also increase bleeding tendencies,
which could endanger the woman's life if she really does have an ongoing
placental abruption.  The combination of the performance of an ultrasound
scan at 7 weeks and the bizarre advice in absence of any measures to insure
the mother's continued survival make me wonder about the judgment of the
obstetrician, if the woman's account is accurate.

If the obstetrician had not been made aware that she was breastfeeding a 20
month old it would never in a million years have occurred to him to say
anything about it.  It doesn't sound as if she has been cautioned about not
putting anything whatsoever in her vagina either.  The whole scenario sounds
off, frankly, and if the doctor really did say and do all these things,
perhaps the body who oversees medical practice in her area would be
interested in hearing about it.  As far as weaning is concerned, I would be
willing to go pretty far out on a limb here and say it is totally
irrelevant.  To my knowledge there is no way to stop a miscarriage once it
has begun at 7.5 weeks either.

Is she sure she saw a *real* doctor with a valid license to practice?

Rachel Myr
Kristiansand, Norway

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