Retained Placenta – This course is designed to understand the care of pregnant women and newborn: antenatal, intra-natal and postnatal; breast feeding, family planning, newborn care and ethical issues, The aim of the course is to acquire knowledge and develop competencies regarding midwifery, complicated labour and newborn care including family planning.
Retained Placenta
Retained placenta
The placenta is said to be retained when it is not expelled out even 30 minutes after the birth of the baby or when placenta is not delivered even 7 hour after the delivery of the fetus if active management of 3d stage of labour is not followed, then it is known as retained placenta.
Causes of retained placenta
A. Uterine atony: In cases of
- Uterine inertia
- Grand multi-Para
- Over distension of uterus
- Prolonged labour
- Uterine malformation
- Bigger placental surface area
B. Oxytocic drugs: Ergometrine, Oxytocin
C. Hourglass contracture (constriction ring)
D. Morbidly adherent-placenta
- Placenta accreta
- Placenta increta
- Placenta percreta
A. History:
- History of delivery
- History of per vaginal bleeding A
B. Clinical features of retained placenta
General
- Anemia
- Features of shock
Per abdominal examination (P/A exam): –
- Uterus is soft, not globular shape
- No changes of height of uterus
Per vaginal examination (P/V exam):
- Vaginal bleeding
- Placenta is not felt in vagina and cervix
C. Investigation:
- Blood TC, DC, ESR &Hb%
- Blood sugar
- Blood grouping and Rh typing
- Serum creatinine
- ECG
- Chest X-ray
- USG
Treatment
General
- Open IV channel
- Ready matched blood
- Catheterization
Specific
A. If there is bleeding: placenta should be delivered at once- Oxytocin by- Uterine massage.
B. If placenta is separated and retained Express the placenta by controlled cord traction.
C. If placenta is un-separated and retained manual removal of placenta under G/A.
D. If retained placenta with sepsis – Admission in referral hospital – Intrauterine swab taken for C/S test – Broad spectrum antibiotic is given
E. If morbid adherent-placenta – Hysterectomy
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