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Dr. Pfeiffer
Dr. Pfeiffer, Doctor
Category: OB GYN
Satisfied Customers: 5986
Experience:  Ob/Gyn Doctor
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my daughter had a c-section two weeks ago. at the end of the

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my daughter had a c-section two weeks ago. at the end of the first week she had several fist sized clots fall from the vagina onto the floor. she developed a fever and had a D&C...throughtout this entire two weeks a three inch area of her incision is bleeding. several times a day she puts two doubled up 4x4 pads on it and it soaks with fresh blood. she had two c-sections before this one and never had any problem. she is weak and is still is a lot of pain...does she need a second opinion at this point?
Submitted: 2 years ago.
Category: OB GYN
Expert:  Dr. Pfeiffer replied 2 years ago.

Dr. Pfeiffer :

hello

Dr. Pfeiffer :

what this her first cesarean?


what was the reason for the cesarean?

Dr. Pfeiffer :

sorry...I missed this info in the question.

Customer:

this is her 3rd...accident in teens prevents natural delivery


 


 

Dr. Pfeiffer :

got it..

Customer:

do you need more info

Dr. Pfeiffer :

yes.

Dr. Pfeiffer :

was she closed with sutures under the skin or staples?

Dr. Pfeiffer :

did she have retained placenta noted on the D&C?

Dr. Pfeiffer :

was she placed on antibiotics?

Customer:

sutures inside staples outside


 

Customer:

no placent


 

Customer:

now on keflex

Dr. Pfeiffer :

ok..thanks

Dr. Pfeiffer :

as far as the bleeding goes...not terribly uncommon to see this happen.

Dr. Pfeiffer :

this is because the more times the uterus is cut (repeat cesareans) the deeper the placent can grow into the muscle of the uterus.

Customer:

two weeks later she is using several doubled 4x4 guaze pads that soak with fresh blood

Dr. Pfeiffer :

ok...the first part was the vaginal bleeding.

Dr. Pfeiffer :

the part with the incsion....

Customer:

and her pain is not subsiding

Dr. Pfeiffer :

now, sounds like she also had a small infection

Customer:

she is pale and anemic


 


 

Customer:

yes in incision and into the abdomen

Dr. Pfeiffer :

when it comes to the bleeding...usually it is leaking of collected blood from under the skin

Dr. Pfeiffer :

fresh blood suggests more active bleeding..and the way the abdomen is closed this is usually from the skin or the fat just beneath the skin.

Customer:

there is a large "blister" looking thing on the outside that continues to fill with fresh red blood

Dr. Pfeiffer :

probably due to infection.

Dr. Pfeiffer :

she should be on an iron supplement by now...

Customer:

should she stay with the same doctor of get a second opinion...she bounced right back without complications from her other sections

Customer:

they were giving her liquid iron in hospital...she had a four day stay then went back for the d&c


 

Dr. Pfeiffer :

Ok...honestly, sounds like her treatment has been appropriate this far..

Customer:

how long should we expect this bleeding

Dr. Pfeiffer :

these types of problems are a bit more common with subsequent cesareans...and that due to the amount of scar tissue.

Dr. Pfeiffer :

I would give it the week of keflex...the infection and bleeding should clear by then.

Customer:

she was in surgery for over one and a half hours taking out scar tissue and had her tubes tied


 

Dr. Pfeiffer :

if not, I think it's completely reasonable to have her ask for a second opinion.

Customer:

it's been four days on keflex without any results and her pain is a #7 or8 on the pain scale...this is not like her

Customer:

what would happen if a piece of gauze or sponge was left in by accident...what would we see?

Dr. Pfeiffer :

yes...that's a possiblity.


and usually it causes women to get ill...fever, chills..etc.

Dr. Pfeiffer :

on day 7..if she isn't better ask to have an abdominal X-Ray done.

Customer:

pain? bleeding?

Dr. Pfeiffer :

there are fibers in the sponges that can be seen with a simple X-Ray

Customer:

so day 7 of keflex you mean?

Dr. Pfeiffer :

I have heard of both pain and no pain...so I can't say pain would be a reliable predictor.

Dr. Pfeiffer :

yes...day 7 of keflex.

Customer:

might it cause blood to have to escape?

Customer:

what is the likelyhood it could be a small bleed internally?

Dr. Pfeiffer :

no..I wouldn't think so

Dr. Pfeiffer :

right...so, it's unlikely to be deep inside..usually the skin or fat just beneath it

Dr. Pfeiffer :

because the abdomen can hold a lot of blood...

Customer:

a week after section her uterus was above her navel and that seemed strange to me


 

Customer:

it came down after she dropped several fist sized clots

Dr. Pfeiffer :

yes...that is unusual

Dr. Pfeiffer :

and that's the reason...

Dr. Pfeiffer :

when there are clost in the uterus it cannot contract and shrink down, which is what causes a woman to stop bleeding.

Customer:

nobody in the hospital was checking her incision and nobody took off the dressing or felt or massaged her uterus...i thought that was very strange

Dr. Pfeiffer :

personal preference I guess..

Dr. Pfeiffer :

I remove the dressing at 24 hours and check the incsion myself daily.

Dr. Pfeiffer :

the nurses are usually trained to evaluate the the uterus at least daily.

Customer:

they were noting that the incision was clean and dry but nobody had looked at it and they didn't know the bandage was on until she left on the fourth day...i am a nurse so i stayed with her

Dr. Pfeiffer :

Yes..that is unusual in my opinion.

Customer:

but i havent worked ob in so many years i thought a lot must have changed

Customer:

the staff is in trouble for all of the false documentation....but we have not formally complained

Dr. Pfeiffer :

no...the basics of surgery are the same.

Dr. Pfeiffer :

I would bring it up to someone...there seems to be a lack of training there.

Customer:

so...keep taking the keflex, watch fever, watch her color and pain level and see if bleeding slows for hopefully stop...when would you think at the end of the keflex it's time for second opinion

Dr. Pfeiffer :

yes...exactly


and...make sure she it taking an iron supplement twice a day.

Customer:

they d/c her iron after she had 3 bags of blood because her numbers looked good but she has always been anemic

Dr. Pfeiffer :

well...

Dr. Pfeiffer :

ok

Customer:

we should ask for new blood work too i think

Dr. Pfeiffer :

usually we don't transfuse to 'normal' because the RBCs don't live that long

Dr. Pfeiffer :

yes

Dr. Pfeiffer :

we usually transfuse to low normal and then put a woman on iron.


 

Customer:

well i mean after transfusing it was up to normal and then they stopped her liquid iron

Dr. Pfeiffer :

if you transfuse to normal you can suppress the bone marrow from making more RBCs because everything seems normal, but it is transient.

Dr. Pfeiffer :

so...iron is probably a good idea for her, but getting the blood test will confirm that

Customer:

so you don't think it sounds like a slow abdominal bleed then?


 

Dr. Pfeiffer :

no..not in my opinion.

Dr. Pfeiffer :

the fascia is closed so any abdominal bleed would be confined in the abdomen

Dr. Pfeiffer :

so when there is bleeding from the incsion it is usually from the layers above the fascia.

Customer:

and what would we see from that? from the slow abd bleed? her belly is a little hard and much too sore to palpate

Dr. Pfeiffer :

very rarely the fasical closure well separate, but if there were fresh blood and that were the cause she would be near death by now.

Customer:

ok...or possibly an area can't heal up around a sponge?

Customer:

before the bleeding she had pus with a foul odor

Dr. Pfeiffer :

that sounds like a wound infection

Customer:

so blood would automatically come next?

Dr. Pfeiffer :

not uncommon...the inflammation makes the vessels more porus...I guess is how I would phrase it.

Customer:

ok...how long should we expect it to bleed so heavily then?

Customer:

it's approx 90cc a day now

Dr. Pfeiffer :

I'd give it the next 3 days of keflex and if she is bleeding enough, that you as a nurse, is concerned about I would get the second opinion.

Dr. Pfeiffer :

that's quite a bit.

Customer:

i think so too

Customer:

ok...thanks for letting me pick your brain...anything else you should tell me to watch for?

Dr. Pfeiffer :

the ones you mentioned earlier...and

Dr. Pfeiffer :

tachycardia, nausea/vomiting, near syncope, dizziness..etc...all the signs that she is profoundly anemic and needs to be seen in the ER.

Customer:

ok...i did take her there when she had all these sign when she had the D&C....she is terribly pale and i am going to ask for new blood work tomorrow as well...

Dr. Pfeiffer :

good plan

Customer:

thank you...you've been helpful in that you said most everything that i was thinking about

Customer:

have a good night

Dr. Pfeiffer, Doctor
Category: OB GYN
Satisfied Customers: 5986
Experience: Ob/Gyn Doctor
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