Lactogenesis Failure Following Successful Delivery of Advanced Abdominal Pregnancy

Abstract

Abdominal pregnancy is a rare condition with significant risk of maternal and fetal morbidity and mortality. Because of the vascular involvement, the placenta is often left in situ. Prior reports have neglected to discuss the implications of leaving the placenta in situ on breastfeeding and lactation. We present a case of failure of lactogenesis II following the successful delivery of an advanced abdominal pregnancy in which the placenta was left in situ. This is the first report to discuss the effects on lactation of leaving the placenta in situ as a conservative management option in advanced abdominal pregnancy.

Abdominal pregnancy: Methods of hemorrhage control

“…Others have preferred leaving the placenta behind (15). But this practice is accompanied by serious risks like secondary hemorrhage, sepsis, failure of lactation, disseminated coagulation, fistulae formation and bowel obstruction due to adhesions (6,16,17).…”

Full-term abdominal extrauterine pregnancy complicated by post-operative ascites with successful outcome: a case report

“…Removing the placenta can result in catastrophic hemorrhage [3] and damage to adjacent structures, whereas leaving it in situ may lead to secondary hemorrhage, abscess formation, adhesions, coagulopathy, continued pre-eclampsia, failure of lactogenesis [18], a need for second surgery and a need for longer follow-up among other complications.…”

Impaired Lactation: Review of Delayed Lactogenesis and Insufficient Lactation

“…Approximately 2% to 3.3% of women experience retained placenta immediately following birth 37 . If fragments of the placenta remain within the uterus after birth, the placental lactogenic hormones can continue to act as antagonists to mammary prolactin receptors and the preservation of elevated circulating levels of progesterone will interfere with secretory activation, 38 leading to either delayed lactation 38 or insufficient lactation 11 …”