Pamela, When a client has excessive bleeding PP AND delayed lactogenesis
II I always think about retained placenta and start asking questions. I
don't know if progesterone or any other hormone blood test would give a
difinitive answer on retained placenta. A very high HCG level which is
consistent with pregnancy is very suggestive of the body thinking it is
still pregnant from  retained placental fragment. You probably should do
an ultrasound to determine this, since hormone levels can vary so much.
The client in the case study in the JHL May,2001 had a very high HCG.
Her prolactin level was also high. An ultrasound and MRI diagnosed the
retained placenta. You are fortunate that the doc is interested in
following this up. Some are resistent to the idea that retained placenta
is related to delay in milk production.I would love to see more studies
done on this.Good luck.
Ann Anderson, RN,IBCLC
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