Retained placenta
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Retained placenta

Retained placenta

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Retained placenta Presentation Transcript

  • 1. E-mail: elnashar53@hotmail.com Aboubakr Elnashar
  • 2. After delivery of the baby, the placenta normally detaches from the uterus and is expelled, often with additional pushing efforts by the mother. Normally this occurs within a few minutes of delivery of the baby. Aboubakr Elnashar
  • 3. Signs of placental separation: 1. Lengthening of the visible portion of the umbilical cord. 2. Increased bleeding from the vagina. 3. Change in shape of the uterus from flat (discoid) to round (globular). 4. The placenta being expelled from the vagina. Aboubakr Elnashar
  • 4. Definition Retention of the placenta in utero for more than 30 minutes. Aboubakr Elnashar
  • 5. Management •Depend on severity of bleeding. The retained or partially detached placenta interferes with uterine contraction and retraction and leads to bleeding. •Bleeding may be visible or may manifest only by the increasing size of the uterus. In the absence of any evidence of placental detachment, consider the diagnosis of complete placenta accreta or a variant. This condition may be present with bleeding if only a portion of the placenta is abnormally implanted. Aboubakr Elnashar
  • 6. 1. Ensuring that the bladder is empty {may speed the delivery of the placenta and at least aid in the assessment and control of the uterus}. Aboubakr Elnashar
  • 7. 2. In stable women with minimal bleeding while preparations for a manual removal are being made. Injection into the umbilical cord vein (Carroli, 2002). Saline, oxytocin and saline, prostaglandin and saline, and dextran 70. The studies comparing injection of oxytocin (commonly, 10 IU) and saline (commonly, 20 mL) with expectant management or saline injection alone suggest that this practice indeed reduces the need for manual removal of the placenta. Aboubakr Elnashar
  • 8. 3. Manual removal of the placenta if the above maneuvers have failed to deliver the placenta or if significant bleeding occurs. a.Anesthesia (regional or general) {manual removal can cause considerable abdominal cramping}. Sometimes, IV narcotic analgesia will prove helpful in relieving this discomfort. Nb: The cessation of an oxytocin infusion or the administration of uterine relaxants to promote uterine exploration and manual removal is of questionable value and may lead to increased bleeding. Ultrasound may be useful in select cases. Aboubakr Elnashar
  • 9. b. an elbow-length glove is worn and attention is paid to asepsis. The perineum and vagina must be prepared. The vaginal hand may be immersed in povidone- iodine solution to facilitate easier entry. The hand is passed into the vagina through the cervix and into the lower segment following the umbilical cord. Care is taken to minimize the profile of the hand as it enters, keeping the thumb and fingers together in the shape of a cone to avoid damage. Control of the uterine fundus with the nonvaginal hand is essential. If the placenta is encountered in the lower segment, it is removed. If the placenta is not encountered, the placental edge is sought.Aboubakr Elnashar
  • 10. Separate the placenta from the uterus with a sweeping motion Aboubakr Elnashar
  • 11. After the placenta is mostly separated, curl your palm around the bulk of it. Aboubakr Elnashar
  • 12. Continue to grasp the placenta as you remove it from the uterine cavity. Aboubakr Elnashar
  • 13. c. Once found, the fingers gently develop the space between the placenta and uterus and shear off the placenta. The placenta is pushed to the palmar aspect of the hand and wrist; when it is entirely separated, the hand is withdrawn. d. an oxytocin infusion is running rapidly as the hand is withdrawn {encourage strong uterine contraction}, and then perform uterine massage. Care must be taken to tease out the membranes. e. Once uterine contraction is established, examine the placenta and membranes to determine whether further exploration or curettage is necessary. f. Antibiotics Aboubakr Elnashar
  • 14. Aboubakr Elnashar
  • 15. Placenta Accreta and Percreta I. partial and focal: a. the attachments can be manually broken and the placenta removed. b. It may be necessary to curette the placental bed to reduce bleeding. Recovery is usually satisfactory, although more than the usual amount of post partum bleeding will be noted. Aboubakr Elnashar
  • 16. II. extensive or complete: • you probably won't be able to remove the placenta in other than handfuls of fragments. • Bleeding from this problem will be considerable, and the patient will likely end up with multiple blood transfusions while you prepare her for a life-saving, • post partum uterine artery ligation or hysterectomy. • If surgery is not immediately available, consider tight uterine and/or vaginal packing to slow the bleeding until surgery is available.   Aboubakr Elnashar
  • 17. a retained placenta with absent sonolucent area between the plaenta and uterine wall suggestive of plaenta increta. Aboubakr Elnashar
  • 18. Repeat USG showing increased echogenicityAboubakr Elnashar
  • 19. Aboubakr Elnashar
  • 20. Thanks Aboubakr Elnashar