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Postpartum hemorrhage
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Wade D. Schwendemann, William J. Watson
Treatment for retained placenta involves extraction of remaining placental tissue. This can be accomplished either through manual exploration or through surgical intervention. Prior to either intervention, care should be taken to ensure adequate anesthesia for the patient. Either IV narcotic medications or re-dosage of a previously placed epidural catheter can be safely performed in the patient with postpartum hemorrhage. Manual exploration and removal of retained placental tissue through curettage with a banjo curette can be safely performed in the delivery room. Bedside ultrasound can be invaluable in this clinical situation. Real-time ultrasound is used to assess for retained tissue and as a guide for surgical procedures. In curettage for suspected retained placenta, the clinician should select the largest curette that can be safely passed through the cervix in order to minimize the risk of uterine perforation. Generally, a banjo curette can be easily passed through the dilated cervix in the immediate postpartum period.
Retained Placenta
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
After the delivery of the fetus, inadequate myometrial contractions, especially in the placental bed, have been implicated in the pathogenesis of retained placenta. Inadequate myometrial contractions are also observed in preterm deliveries and atonic PPH. Therefore, the risk factors for a retained placenta parallel those for uterine atony (discussed in Chapter 14). While a history of a retained placenta in a previous pregnancy is a risk factor, current infection of the uterus may also predispose to a retained placenta. It has been shown that a retained placenta is associated with pre-eclampsia, stillbirth and delivery of a small for gestational age infant, raising the suspicion of a common pathophysiologic pathway between defective disorders of placentation, poor obstetric outcome and placental retention.
Major obstetric haemorrhage
Published in Jennifer Duguid, Lawrence Tim Goodnough, Michael J. Desmond, Transfusion Medicine in Practice, 2020
Retained placenta complicates 1–2% of all deliveries, and is sometimes (but not invariably) associated with blood loss. Retained products of conception almost always prevent the uterus from contracting down effectively, and will cause some bleeding.
The association between acute lower abdominal pain over a previous caesarean scar and uterine rupture
Published in Journal of Obstetrics and Gynaecology, 2022
Maya Frank Wolf, Maayan Ben-Nun, Inshirah Sgayer, Oleg Shnaider, Alaa Aiob, Marwan Odeh, Jacob Bornstein
The second case was of a 38-year old healthy female, G3P2, with uncomplicated pregnancy course. She underwent labour induction due to suspicious foetal monitoring at 38w + 5d by cervical foley catheter which was followed by induction with Pitocin. She delivered a female foetus with a birthweight of 3802 g. In addition, manual removal of the placenta was performed due to retained placenta without any reported complications. Several hours after this procedure, she suffered from hypotension and vaginal bleeding and was treated with uterotonics and hydration. A CT angiogram was performed due to a further decrease in haemoglobin which revealed findings of possible UR. She underwent laparotomy and a hysterectomy was performed. In the third case, a healthy female, G1P0, underwent labour induction by a double-balloon catheter and Pitocin due to mild preeclampsia at 38w + 4d. An urgent caesarean section was performed due to variable decelerations and UR was diagnosed in the anterior wall. A healthy newborn was delivered with a birthweight of 2728 grams and Apgar score of 9/10.
Pattern of implementation of Emergency Obstetric Life-Saving Skills in public health facilities in Nsukka Local Government Area of Enugu State, Nigeria
Published in Journal of Obstetrics and Gynaecology, 2022
Scholastica N. Ugwu, Oluwafemi J. Adewusi
The proportion of health workers who always manually remove retained placenta is lower than the report by a past similar study (Oyetunde and Nkwonta 2015). While assisted vaginal delivery using a vacuum extractor was being performed by a few, the rate is higher than vacuum delivery rates reported in other parts of the country (Mairiga et al. 2005; Mutihir and Pam 2008; Yakasai et al. 2015). Similar to other studies, only few of the health workers manage eclampsia with magnesium sulphate (Ramadurg et al. 2016; Sotunsa et al. 2016) however, some other studies reported higher usage of magnesium sulphate (Ishaku et al. 2013; Sheikh et al. 2016). Although the healthcare workers were trained on how to use magnesium sulphate, possible reasons for its low use include fear of toxicity, familiarity and ready availability of pre-packaged forms of less effective drugs such as diazepam, misinformation regarding who can administer the drug, variable procurement in the facilities (Ekele 2009; Kirk and Chattopadhyay 2016).
Experience of Bakri balloon tamponade at a single tertiary centre: a retrospective case series
Published in Journal of Obstetrics and Gynaecology, 2021
Mariana C. Dorkham, Mathias J. Epee-Bekima, Hannah C. Sylvester, Scott W. White
At our centre, IUBT is indicated as a second-line intervention for postpartum haemorrhage, where medication management has failed. Medical management encompasses the use of oxytocics, tranexamic acid, bimanual compression, and manual removal of retained placenta. Repair of trauma may also precede IUBT but can also occur concurrently. Decision to proceed to IUBT is at the discretion of the treating clinicians; however in general, blood loss continuing above 1000 mL is an indication to proceed to second-line management. All women undergoing IUBT are admitted to the Adult Special Care Unit (ASCU), a maternal high-dependency unit, until the balloon has been removed. The current institutional protocol for deflation suggests deflation of the balloon all at once or in two stages, with 50% initially then the remainder after 30 minutes. All patients are fasted for at least six hours prior to balloon deflation, in case return to theatre or further intervention is required, and deflation only occurs between the hours of 0800 and 1700, with theatres on standby, as per the relevant clinical guideline.