An article on Retained placenta
The placenta is about to be retained when it is not expelled out even 30 minutes after the birth of the baby from the womb of the mother.
Causes:
Placenta completely separated but retained is due to poor voluntary expulsive efforts specially following exhaustive and prolonged labour.
Simple adherent placenta due to uterine atony.
Placenta incarcerated following due to constriction ring.
Diagnosis:
By observing the time from delivery of baby to more than 30 minutes.
Placenta separation features are not evident.
Complications:
- Haemorrhage may be seen
- Shock due to blood loss
- Puerperal sepsis may occur
- Risk of its occurance in next pregnancy.
Management:
Manual removal is performed with full aseptic precautions.
With the left hand the umbilical cord is held while the right hand is coned and inserted into the vagina and uterus following the directions of the cord .
.once the placenta is located the cord is released.
The operator will feel for a separated edge of the placenta.
The fingers of the right hand are extended the border of the hand is gently eased between the placenta as the uterine wall.
With a sideway and slicing movement of placenta is detached.
The placenta should be checked immediately for completeness so that any further exploration of the uterus may be carried out with delay.
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