palcental delivery during lscs

1. PLACENTAL DELIVERY
DURING LSCS
Dr gitanjali kumari
Jr-3
Department of obstetric & gynaecology

2. • Two common methods used to deliver the placenta at CS are cord traction and manual removal.
• Manual removal of the placenta which the obstetrician introduce his hand into the uterine cavity to cleave the
placenta from the decidua basalis as soon as possible after the delivery of the infant
• controlled cord traction in which the obstetrician do external uterine massage and gentle traction on the
exposed umbilical cord to facilitate placental delivery.
• Opinions differ about the best for placental delivery technique at CS. Some trials showed a reduced risk of
blood loss with controlled cord traction and others showed that manual removal of placenta at CS do not
increase perioperative blood loss.
• It was concluded that manual delivery of the placenta was significantly associated with greater operative
blood loss and greater decrease in postoperative hemoglobin levels and postpartum maternal infectious
morbidity but with shorter operative time compared with spontaneous placental separation .

3. • Caesarean section rates are rising worldwide and becoming a cause for concern as caesarean section has
been shown to be positively associated with maternal mortality and severe morbidity, even after adjusting for
risk factors .
• After delivery of the baby by caesarean section, it is common practice to administer intravenous oxytocin to
the mother and deliver the placenta by controlled cord traction.
• Massaging the uterine fundus may help to separate the placenta from the endometrium.
• In this procedure, manual removal of the placenta is carried out only if there is a delay in its separation and
expulsion.
• An alternative method is to remove the placenta manually immediately after delivery of the baby. Although the
latter approach may be quicker, it may increase the risk of significant blood loss and endometritis . Some
studies, however, have not shown an increased risk of morbidity from immediate manual removal of the
placenta

4. 1. Active bleeding
2. Uterus well retracted
3. Completeness of
placenta

7. REMOVAL OF PLACENTA
• After delivery of baby ,let the placenta separate on its own,don’t rush.
• AMTSL should be DONE
• An area near the fundus is felt spongy where placenta is attached -> after placental separation it becomes
well retracted
• Don’t unnecessarily mop the uterus ,mopping is associated with increased risk of endometriosis
• See for uterine tone
• Any active BLEEDING
• See for placental completeness

8. • THANK YOU