Considering D&C for Retained Products of Conception
I am a 28-year-old female, maintaining a healthy weight and living with von Willebrand disease alongside a platelet disorder. Tragically, I experienced a stillbirth at 25 weeks yesterday. Initially, my bleeding had decreased; however, today it intensified with bright red blood. Following guidance from my hematologist, I sought emergency care where I received platelets, leading to a noticeable reduction in bleeding. An ultrasound indicated there may be retained products of conception. Despite this, the medical team is cautious about proceeding with a D&C, as they are concerned it could exacerbate the bleeding. Currently, I've got a surgical procedure scheduled for tomorrow, but I'm facing a difficult decision. I would appreciate your thoughts on what actions you would take if faced with a similar situation. Regarding the ultrasound findings: The thickness of the endometrium was noted at 11 mm, with the presence of heterogeneous debris in the endometrial canal along with localized increased Doppler flow.
Answers (1)
7/1/2025, 10:01:40 PM
OpenHealth AI
I’m truly sorry to hear about your stillbirth and the challenging situation you’re currently facing. It's normal to feel overwhelmed, especially when dealing with complex health issues and emotional distress. Your safety and well-being are the top priority as you navigate this difficult time.
Given your background with von Willebrand disease and a platelet disorder, plus the current ultrasound findings of retained products of conception, here’s a structured look at your situation:
Main Points:
- Bleeding Management & Risks: Your concerns about bright red bleeding and the potential for a D&C to exacerbate this risk must be carefully weighed.
- Retained Products of Conception: It's important to address the retained products to prevent complications like infection or prolonged bleeding.
- Careful Decision Regarding D&C: You'll need to consider if the benefits of proceeding with a D&C outweigh the risks given your bleeding tendencies.
Explanation:
- Retained Products: This can happen after a stillbirth or miscarriage, and addressing it typically involves surgical intervention if the body doesn’t clear it naturally. However, with your bleeding complications, it's reasonable for healthcare providers to be cautious.
- Recent Bleeding: Bright red blood can indicate fresh bleeding, which may need urgent evaluation to ensure safety, especially considering you may have low platelet counts.
- Ultrasound Findings: Heterogeneous debris suggests the presence of retained products, while increased Doppler flow may indicate how actively blood is flowing in that area, which could relate to how your body is responding to the retained tissue.
Next Steps:
- Communicate Clearly with Your Healthcare Team: Make sure to express your fears and preferences regarding the D&C clearly. Discuss the risks and benefits considering your specific conditions.
- Consider Non-Invasive Options First: If feasible and safe, inquire whether monitoring the situation further and allowing your body time to pass the products naturally could be a viable option, possibly combined with medication to aid the process.
- Have a Hematology Input: Ensure the hematologist is involved throughout this decision, especially about managing your bleeding risks pre- and post-procedure.
- Post-Procedure Support: If you proceed with a D&C, discuss what support or precautions will be in place immediately after to manage any bleeding and ensure recovery is as smooth as possible given your underlying conditions.
While this is undoubtedly a heartbreaking time, do remember that you are not alone, and your healthcare team aims to provide the best possible support. If you have more specific concerns or questions during this process or after discussing with your team, feel free to ask.
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