PPH. Will it happen again?

[Nousername2015]

Looking for some advice from experienced folk please, bear with me for this though!
I had medical management for a mmc in March this year. I went into hospital to have the procedure, however I had to have a manual placenta removal due to continued heavy blood clots and bleeding which revealed a stuck placenta when examined.
It has gone down on my notes as pph.
I'm currently 34 weeks pregnant and just wondered what the chances of this happening again could be? And was this really a pph? I didn't have a transfusion, just spent the night in hospital due to bp being low and suffering from cervical shock.
This will be my 'first' baby so have no idea what to expect really. If anybody has suffered with pph in the past, is there a recommendation to have a natural or managed third stage to minimise the risk?

I've had a small PPH (750ml, whereas 'normal' blood loss is 500ml) and have been advised to have a managed third stage. Friends who have had bigger PPHs have been advised to get cannulas placed early so that, if it does happen again, there is already IV access for fluids (and blood if necessary).

Have you got to see a consultant to talk things through in terms of your risks etc?

No, I'm considered low risk and under midwife care. I'm also hoping to give birth in a midwife led unit (not attached to maternity ward) who have seen my notes and are happy to take me as long as my labour meets the criteria. I'm doing my birth plan with my midwife in a couple of weeks though and do want to focus on this as if there is a risk it will reoccur then I will go to the main hospital for the birth. Thank you for sharing your advice.

I had a mmc a year before DD was born. They never said I had retained placenta and I didn't gave a manual removal but 3 weeks after the medical management I had some very large clots due to retaining some of the pregnancy. I didn't bleed nearly as much post birth and the bleeding stopped quicker than my mmc. I think my notes say I lost 400ml when DD was born. I did have a managed third stage in the midwife led unit.

I think you need to speak to your MW. No one can ever say that there is no risk that it will happen again (5% of women will have a PPH) and you are at a increased risk if it was a PPH, but perhaps the notes have put it down as a PPH when reading the notes more carefully has suggested that it wasn't that bad, which has reassured the midwife who read your notes. Impossible to say from here!

Personally, I wouldn't give birth with my history of a PPH in a midwife led unit not in the same place as a delivery unit. I'd want to know that there were doctors near by if things went a pear-shaped. That said, this time round I am likely to book a homebirth, but only as a precaution as I deliver very quickly, with my actual plan being to go to the birth centre in the same hospital as the delivery unit.

The Royal College of Obs and Gynae have done a good patient information leaflet that might help your conversation with your midwife:

www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/heavy-bleeding-after-birth.pdf

Hope it all goes well!

I've had two. I knew there was a risk second time round, they were more prepared. I had a cannula, fluids running and various drugs afterwards to make my womb contract and stop me bleeding. Both PPH's were very different, the first was a lot of blood quite quickly and the second was a slow bleed and I had to stay in hospital longer. I was on the mlu both times as the other side was full. The second time was definitely managed better as they were prepared for it.

I had exactly the same experiences as JibberJabber. To the letter.

I had a 1 litre PPH last time. This time I have to be on the labour ward and have a cannula sited on admission. Also a managed 3rd stage. Hopeful things will be different this time!

I previously had a MMC with surgical management (no problems) and then a PPH of 750ml with my first birth. I was under MW only care but had been transferred to the delivery unit and was in theatre at the time of the PPH. Managed third stage was in my birth plan anyway.

I'm down as low risk so on MW only care again for current pregnancy. I've been told I'm at no more risk of a PPH this time than someone who hadn't had 1 before. Very happy to have managed third stage again regardless, but I'm not a natural-is-better kind of person anyway!