• Reference Number: HEY1120/2023
• Departments: Maternity Services
• Last Updated: 3 April 2023

Introduction

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but it may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

Ragged membranes

This terminology applies if you were informed following the birth of your baby and the placenta that you had ‘ragged membranes’ or ‘piecemeal products’. This leaflet refers to ‘baby’ in the singular but also applies to you if you have had a multiple birth.

Ragged membranes mean that the sac (membranes) surrounding your baby whilst they were in the womb was noted to be ragged (with rough edges) when it was delivered with the placenta or that parts of the placenta came out in pieces after your baby was born.

It is normal to bleed from your vagina after you have a baby. This blood mainly comes from the area in your womb (uterus) where the placenta was attached but it may also come from any cuts and tears that happened during the birth.  Bleeding is usually heaviest just after birth and gradually reduces over the next few hours and days. This vaginal bleeding is called the lochia and it will usually have stopped by the time your baby is 12 weeks old.

You may have the symptoms of:

• Much heavier bleeding than would be expected following birth (a post-partum haemorrhage)
• Passing vaginal blood clots
• Smelly blood loss (with an offensive smell)
• Feeling unwell (flu-like symptoms: fever, feeling hot and cold, feeling shivery, extreme tiredness, reduced appetite)
• Severe abdominal pain
• Chest pain and / or breathing very fast
• Vomiting
• Diarrhoea
• Difficulties in passing urine or pain when you pass urine

Can there be any complications or risks?

If you have been told that you had ragged membranes or piecemeal products, you may be at risk of complications from this.

These can be:

• Parts of the membranes or placenta still being inside your womb
• Developing an infection
• Heavy vaginal bleeding

What should I do if I have these symptoms?

If they are mild, contact your midwife, GP, NHS 111 or an NHS walk-in centre for advice.

If the bleeding is excessive or you feel extremely unwell, attend the Emergency Department at the hospital. Call 999 if someone you are caring for is unconscious or bleeding excessively and not well enough to transport themselves to hospital.

How will I be treated if this happens?

You will have basic observations performed (temperature, pulse, blood pressure, respiratory rate and oxygen saturation), vaginal swab may be taken to diagnose an infection and blood tests may be performed. You may have a gentle vaginal examination performed and the doctor / midwife may need to gently press on your stomach to see if any clots will come out of your vagina. A pelvic ultrasound scan may also be performed to assist with making a diagnosis.

You may be treated with antibiotics if an infection is suspected, orally or intravenously through a cannula if the infection is severe.

Occasionally, an operation may be needed to remove any small pieces of remaining placenta from your womb and you may need to stay in hospital for a few days. Your baby can usually stay with you if you wish and you can continue to breastfeed.

Further information

Harding & Cox (2015) Postpartum Haemorrhage https://patient.info/doctor/postpartum-haemorrhage

RCOG (2016) Heavy Bleeding after birth (postpartum haemorrhage) https://www.rcog.org.uk/en/patients/patient-leaflets/heavy-bleeding-after-birth-postpartum-haemorrhage/

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Maternity Services (1482) 604490

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.