artificial placental abruption

Manual stripping of the placenta is performed by hand peeling off the surgery that is retained in the intrauterine placenta. Treatment of diseases: partial residue of placenta Indication 1. After the baby is delivered, part of the placenta is peeled off and causes massive bleeding in the uterus. After the massage is performed at the end of the palace or with a uterine contraction, the placenta cannot be completely discharged. 2. 30 minutes after the delivery of the fetus, the placenta has not been stripped. Contraindications Implantable placenta, do not force stripping. Preoperative preparation 1. Bladder lithotomy position, disinfection of vulva and exposed umbilical cord, removal of sterile towels, singles, surgeons for sterile gloves and surgical gowns, or wearing sterile cuffs outside the original surgical gown. Catheterization. 2. Intramuscular injection of meperidine 100mg, intravenous anesthesia or general anesthesia in the trachea, individual can not give anesthesia, but must be clearly explained to the patient, in order to cooperate. 3. Infusion, oxytocin 10U slow intravenous injection, intramuscular injection or injection into the fundus muscle through the abdominal wall. Surgical procedure 1. The surgeon holds the umbilical cord in one hand and the lubricant in the other hand. The five fingers are closed into a cone shape, and enter the vagina and uterine cavity along the umbilical cord to find out the place where the placenta is attached. 2. One hand presses the bottom of the abdomen under the abdominal wall, the palm of the uterus expands, the four fingers close together, the back of the hand clings to the wall of the palace, and the side of the finger and the lateral edge of the ankle move upward and left, and the placenta is peeled off from the wall of the palace. At the beginning, there is a layer of smooth membrane between the finger and the placenta. After the membrane is broken, the finger directly contacts the placenta and the wall of the placenta. Generally, there is no difficulty in peeling off. In case of resistance, it should be carefully peeled off with both hands inside and outside. When a little cable-like adhesive tape is used, it can be disconnected with your fingers. The adhesion surface is wide and tight, and it cannot be peeled off by hand. It may be adhesion or implantation of the placenta. The operation should be stopped immediately. Strengthen uterine contractions, ergometrine 0.2mg intramuscular injection or intravenous injection, if bleeding is not much, you can temporarily observe, give oxytocin. If there is more bleeding, it will be treated with laparotomy. 3. If the placenta is attached to the front wall, the palm is peeled off the anterior wall to the uterine wall to peel off the placenta. 4. It is estimated that most of it has been peeled off, and the umbilical cord can be pulled again in one hand to help identify and separate the remaining part, then hold the placenta in the hand and pull it downwards while rotating. Be careful not to use strong traction to avoid residual part of the placenta or membrane. 5. Check the placenta and fetal membrane for defects, and reach into the uterine cavity to remove residual tissue. It can also be grasped with an oval clamp under the guidance of a finger, or scraped with a large blunt curette. Pay attention to check the uterus for damage. complication Uterine bleeding It mainly occurs when the placenta is difficult to peel off or the peeling is incomplete, which affects the contraction of the uterus and causes massive bleeding. Experienced people should be asked to complete the operation quickly, remove the contents of the uterus, and strengthen the contractions and control bleeding. Can not effectively control the emergency treatment of laparotomy. 2. Uterine injury or perforation It often occurs in cases of improper operation or placenta implantation. I have seen individual birth attendants use the cervix as a placenta and tear off the anterior wall of the vagina to cause severe urinary fistula. The uterus perforation is small, and when there is not much bleeding, it can be closely observed with uterine contractions and antibiotics. Patients with severe uterine injury or bleeding should be opened for exploration and repaired or removed. 3. Postpartum infection After removing the placenta by hand, antibiotics should be routinely administered and the signs of infection should be closely observed.

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