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Q&A

Physiology/Endocrinology

Poster Session 3

(761) Impact of Retained Placenta on Breastmilk Production in Individuals Undergoing Conservative Management of PAS

Wednesday, February 14, 2024

8:30 AM – 10:00 AM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Jennie Coselli, MD

MFM Fellow
Department of Obstetrics, Gynecology and Reproductive Sciences McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, TX, United States

Coauthor(s)

Elias Kassir, MD (he/him/his)

Maternal-Fetal Medicine Fellow
McGovern Medical School at UTHealth Houston
Houston, TX, United States
Rylee Trotter, BBA (she/her/hers)

Medical Student
University of Texas-Houston Medical School
Houston, TX, United States
KL

Katherine Lambert, BS

Medical Student
McGovern Medical School at UTHealth Houston
Houston, TX, United States
Baha M. Sibai, MD

Professor
Hermann Memorial Hospital
Houston, TX, United States
PB

Pamela Berens, MD

McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, TX, United States

Objective: Conservative management of placenta accreta spectrum (PAS) includes delivery of the infant with retention of the placenta in situ. It has been suggested that retained placenta may adversely impact milk supply. There is insufficient data on the impact of leaving the placenta in situ with PAS and ability to establish lactation. Progesterone is believed to disrupt prolactin binding to alveolar cell receptors within the breast. Placenta delivery with subsequent fall in progesterone removes this inhibitory effect and allows full milk supply. Our objective is to gather information related to lactation in women with planned placental retention.

Study Design: We performed a prospective cohort study among pregnant individuals diagnosed with PAS in a tertiary county hospital system. We obtained progesterone and beta hCG levels for individuals undergoing either conservative management (with placenta left in situ and delayed hysterectomy) or cesarean hysterectomy. Chart review of lactation notes from each individual’s inpatient hospitalization assessed whether they were breastfeeding or not, and, if breastfeeding, the approximate time for milk production to come in.

Results: The percentage of individuals who breastfed in the cesarean hysterectomy group was 62.5%. The percentage of individuals who breastfed in the conservative management group was 66.7%. The average progesterone levels postpartum were 62.9 ng/mL in the conservative management group compared to 1.86 ng/mL in the cesarean hysterectomy group. The average time for milk supply to come in was 5.6 days for conservative management and 3 days for cesarean hysterectomy.

Conclusion: This information is important for future counseling on the impact of retained placenta on breastfeeding outcomes among the pregnant individuals considering conservative management of PAS. Continued research efforts are needed to better understand changes in progesterone and beta hCG levels associated with planned placental retention and implications on breastfeeding and milk supply.