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Maternal (Expert Forum)
Bleeding after DNC - placenta accreta?
Patient medical question and answer from The Maternal and Child Health Forum. Health topic area and articles about newborn care
Bleeding after DNC - placenta accreta?
by Becky__0, Jan 06, 1999 12:00AM
Here's the sequence of events:
1) At 10-1/2 weeks of first pregnancy, ultrasound reveals amniotic sac but no fetus. HCG = 265,000. Dr. suspects molar pregnancy. No history of bleeding during pregnancy.
2) 3 days later, HCG is 250,000
3) 11-1/2 weeks: DNC pathology indicates it is NOT a molar pregnancy; indicates denegerated chorionic villi
4) 1 week post op: Gushing bleeding (lasts 1/2 day) and clotting
5) 2 weeks post op: HCG = 1900
6) 2 weeks post op: Gushing bleeding (lasts 1/2 hour) and clotting
7) 3 weeks post op: Gushing bleeding (lasts 1/2 hour) and clotting; every other day for 8 days
8) 3-1/2 weeks post op: HCG = 500
9) 5 weeks post op: cramping & clots but no gushing. Ultrasound reveals tissue remaining in uterus; Dr. says might be placenta left behind in 2nd layer - described placenta accreta. I have no history of scarring, previous miscarriage, surgery, etc. Also, Dr. says my uterus has a slight septum. HCG = 98; we'll monitor but no additional intervention at this time. DNC pathology indicates all of the pregnancy was removed.
Questions:
Q1) What could be left behind? Could it be placenta accreta? If not, what?
Q2) If it is placenta accreta, could this cause scarring and problems with future implantation?
Q3) If it is placenta accreta, could this increase my chances for having this with future pregnancies?
Q4) Could the septum in my uterus cause any problems conceiving or carrying a baby full term?
Q5) What could cause the HCG to be so high initially? Dr. says tissue left behind and what caused inital abnormal fetus are unrelated.
Thank you for any information you can give me. The postings are very helpful but I didn't see this exact situation.
Dear Becky:
During normal placentation (attachment of the placenta into the wall of the uterus), some tissue grows deeply into the wall (anchoring villi) and they are not easily removed by D and C. I believe this is what you are being told is the "second layer". Thus, the tissue left behind is trophoblast.
The diagnosis is degenerating placental tissue and the "pregnancy" which would be the fetal tissue has been removed.
One follows the hCG levels to assure the become undetectable. If hCG persists, there is persisting trophoblast.
Placenta accreta is abnormal placentation in which the trophoblast fails to separate from the wall of the uterus.
The placental site heals by scar, whether this is normal or abnormal placentation. Scar can make it more difficult for a future placenta that attaches in the same area to separate. It is less likely to have implications for becoming pregnant or carrying a pregnancy.
A uterine septum can contribute to miscarriage. The size of the septum and treatment must await the uterus returning to its non-pregnant size.
High hCG levels are associated with multiple pregnancy, abnormal placenta due to disease (infection, erythroblastosis, diabetes are examples) and trophoblastic disease (abnormal formation and growth of placental tissue).
Keywords: high hCG; placenta accreta
This information is provided for education purposes and is not a medical consultation. If you have specific questions, please talk with your physician.
