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Subject:
From:
Rachel Myr <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 26 May 2002 09:41:56 +0200
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While retained placental fragments can be a cause of impaired lactation,
after a cesarean they constitute near-malpractice.

At cesarean the uterine cavity is visualized, inspected, and usually 'wiped
off' with gauze compresses to ensure that all products of conception have
been removed.  If they managed to miss bits of a placenta in there, they
were working under conditions not generally seen in the developed world.  If
the woman's uterine cavity was anomalous in any way and the operators were
not aware of it, this could still be a remote possibility.

A more likely cause of the bleeding is that one or more 'bleeders' didn't
get ligated or cauterized, so that blood is seeping from some part of her
surgical incision.  Normal activity could continue to disrupt the site so
that bleeding doesn't stop.  Still not good, but more understandable than
that the operating team could have overlooked some placenta.  She could also
have an infection.  Neither of these diagnoses precludes the other.

I practice in a high tech setting and am unfamiliar with natural remedies
for retained fragments.  IMO if she suspects retained placenta she should
contact whatever emergency facility is at hand and at the very least find
out how anemic she is, and perhaps an ultrasound to see whether her uterine
cavity looks unusual in any way.

Hope she finds out where the problem is.
Rachel Myr
writing as a midwife now
Kristiansand, Norway

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