Retained placenta in the uterus

Introduction 30 minutes after the delivery of the fetus, the placenta has not yet been delivered, known as placental retention, is an important cause of postpartum hemorrhage. However, if the placenta is not completely stripped from the uterine wall, although the placenta is retained, there may be no bleeding for a period of time. Therefore, the correct treatment of placental retention is important for preventing postpartum hemorrhage and reducing maternal mortality.

Cause

1, placental insufficiency: more common in the uterus contraction, when the placenta has not been stripped, the birth attendant prematurely, excessive intervention, squeezing the uterus, pulling the umbilical cord, causing part of the placenta and uterine aponeurosis layer separation, the other part has not been stripped . In this way, the blood sinus of the placenta exfoliation surface is open and bleeding is not limited.

2, the placenta is not discharged after the stripping: the placenta has been completely stripped from the uterine wall, but due to uterine contraction or abdominal muscle contraction weakness, bladder loss, etc., so that the placenta is retained in the uterine cavity is not discharged, thereby affecting uterine contraction, so that the amount of bleeding increased .

3, placenta incarceration: for some reason, the uterus is spasmodic contraction, the uterus is tight, the placenta is incarcerated in the uterus, sometimes the blood is accumulated in the uterus, showing recessive bleeding, but the mother has blood loss Performance, such as palpitation, pale face, nausea and so on.

4, placental residue: refers to the majority of placenta has been delivered, there are placental leaflets or parafolial placenta remaining on the uterine wall, affecting the normal contraction of the uterus and bleeding.

5, placenta adhesion: refers to part or all of the placenta adhesion to the uterine wall, can not peel off. It is not easy to bleed when all the adhesions; when part of the adhesion, the part that has been peeled off is more bleeding due to sinus cessation. Most of the causes of adhesions are endometritis or endometrial damage. The latter are mostly repeated abortions.

6. Implanted placenta: refers to the damage or dysplasia of the uterine aponeurosis, which causes the placenta to be implanted into the myometrium. Due to the degree of implantation, the placenta is in contact with the myometrium, deep into the muscular layer, or penetrates the uterine serosa. Complete implantation can be no bleeding, and partial implantation can cause major bleeding.

an examination

Related inspection

Obstetric B-hysteroscopy

1. More than half an hour after the delivery of the fetus, the placenta has not yet been delivered.

2. Vaginal bleeding.

3. Exclude coagulopathy and soft birth canal laceration.

4. Stop bleeding, if the placenta has been removed from the uterine wall and not discharged, the bladder should be urinary, empty the bladder, then massage the uterus with one hand to shrink, and gently press the uterus, the other hand gently pull the umbilical cord To assist in the discharge of the placenta. If the placenta has adhesions or the placenta that is expelled is defective, manual stripping of the placenta should be performed to remove the placenta or residual placental tissue. If it is difficult to remove the residual placenta, use a large blunt curette to remove the uterus. If the placenta is incarcerated above the narrow ring and the hand is difficult to remove, it can be removed with a finger under general anesthesia. If it is an implantable placenta, hysterectomy is the safest, and should not be peeled off by hand to avoid uterine perforation and fatal bleeding. If you insist on retaining fertility, you can remove the implanted part and repair the uterine wall or place the placenta in the uterine cavity, until it is gradually dissolved or absorbed, but the infection should be strictly controlled.

5. At the same time as effective hemostasis measures according to the cause, it is necessary to actively carry out prevention and treatment of shock.

6. Anti-infective mothers due to excessive blood loss, can reduce the body's resistance, and produce sputum infection, and even sepsis and life-threatening. Therefore, in addition to the aseptic operation in the rescue process, a large number of antibiotics should be given after the birth, and anemia should be actively corrected to strengthen nutrition.

Differential diagnosis

It needs to be distinguished from the following symptoms:

Placenta preposition: The normal placenta is attached to the posterior wall, anterior wall or side wall of the uterus. If the placenta is attached to the lower part of the uterus, even if the lower edge of the placenta reaches or covers the inner opening of the cervix, its position is lower than the first exposed part of the fetus, called the placenta preposition.

Placental abruption: After 20 weeks of gestation or during childbirth, the placenta in the normal position is partially or completely detached from the uterine wall before the delivery of the fetus, called placental abruption. Placental abruption is a serious complication in the third trimester of pregnancy. The short-term training course is urgent and rapid. If it is not handled in time, it can endanger the mother and child. The incidence of domestic reports is 4.6 to 21 , and the incidence rate abroad is 5.1 to 23.3 . The incidence is related to whether the placenta is carefully examined after delivery. Some patients with mild placental abruption can have no obvious symptoms before labor. Only when the placenta is examined after delivery, it is found that there is clot blockage in the early exfoliation. Such patients are easily overlooked.

Placental aging: Placental aging is the maturity of the placenta, which refers to the degree of aging of the placenta. The lower the degree of maturity, the better the function of the placenta, and the more nutrients it can provide for the baby.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.