What Is a Manual Placenta Removal?

Manual placentalysis is a procedure that removes the placenta remaining in the uterine cavity by hand.

Artificial placenta dissection

Right!

Manual placentalysis is a procedure that removes the placenta remaining in the uterine cavity by hand.

Artificial placenta dissection

Manual removal of placenta; manual removal of retained placenta; manual removal of retained placenta

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Anatomy of the placenta.

Artificial placenta dissection is suitable for:

1. After the fetus is delivered vaginal, the placenta has not been delivered for 30 minutes;

2. Fetus less than 30min after delivery, but vaginal bleeding has reached 200ml;

3. Patients with previous placental adhesions or who were delivered by vaginal surgery under general anesthesia can perform stripping of the hand immediately after delivery.

1. Bladder lithotomy position, disinfection of the vulva and exposed umbilical cord, removal of sterile towels and sheets, replacement of sterile gloves and surgical gown by the operator, or wearing of a sterile sleeve over the original surgical gown. Catheterization.

2. Intramuscular injection of pethidine 100mg, intravenous anesthesia or intratracheal general anesthesia, individual anesthesia may not be given, but the patient must be clear to facilitate cooperation.

3. Infusion, oxytocin 10U is slowly intravenously, intramuscularly or intramuscularly through the abdominal wall.

1. The surgeon holds the umbilical cord in one hand and applies a lubricant to the other. The fingers are folded into a conical shape, enter the vagina and uterine cavity along the umbilical cord, and find out where the placenta is attached.

2. One hand presses the bottom of the palace through the abdominal wall, the palms in the uterine cavity are spread out, the four fingers are close together, the back of the hand is close to the palace wall, the fingertips and the radial side edges are swung up and left and right, the placenta is peeled from the palace wall. At first, there is a layer of silky membrane between the finger and placenta. Later, the membrane is broken, and the finger is in direct contact with the placental mother face and the palace wall. Generally, there is no difficulty in peeling. In case of resistance, it should be carefully peeled with both hands inside and outside, and can be disconnected with fingers when encountering a little cord-like adhesion. The adhesion surface is wide and tight, and those who cannot peel off by hand may be placental adhesion or implantation, and the operation should be stopped immediately. To strengthen uterine contractions, ergometrine 0.2mg can be given intramuscularly or intravenously. If there is not much bleeding, you can temporarily observe and give oxytocin. If there is more bleeding, open surgery.

3. If the placenta is attached to the anterior wall, peel the placenta against the anterior wall with the palm of your hand.

4. It is estimated that most of them have been peeled off. You can pull the umbilical cord with one hand to help identify and separate the rest. Then hold the placenta in your hand and pull it out while rotating. Be careful not to use strong traction to prevent the placenta or membrane from remaining.

5. Check the placenta and placenta for defects, and reach into the uterine cavity to check for residual tissue. You can also use oval forceps under the guidance of your fingers, or scrape with a large blunt spatula. Pay attention to check the uterus for damage.

1. Re-sterilize the vulva, change gloves, and spread towels.

2. Prepare for blood transfusion and infusion.

3 Pull the umbilical cord gently with your left hand, apply lubricant on your right hand, put your five fingers together like a circular cone, and extend the palm along the umbilical cord into the vagina to reach the uterine cavity. Touch the edge of the placenta. Hold the bottom of the uterus on the abdominal wall and push the uterus downwards with your left hand. Press the back of your right hand against the uterine wall with the palm facing the placenta. Gently separate the placenta from the uterine wall from the edge of the placenta or the stripped place.

4 When separation is difficult, it is not forcible. If deep villous implants are found when pulling the umbilical cord, when the placenta is implanted, artificial dissection should be stopped and hysterectomy should be performed instead.

5. Intraoperative and postoperative uterine contractions, intramuscular injection or intravenous injection.

6. Antibiotics prevent infection.

After artificial placenta dissection, do the following:

1. Intravenous or intramuscular injection of ergometrine 0.2mg, if necessary, continuous intravenous drip of oxytocin for 12h, and then oral uterine contraction.

2. Invest in a sufficient amount of broad-spectrum antibiotics.

Uterine bleeding

It mainly occurs when the placenta is difficult to detach or the detachment is incomplete, which affects the uterine contraction and causes major bleeding. Experienced persons should be invited to complete the operation quickly to remove the contents of the uterus, while strengthening the contractions and controlling bleeding. When the disease cannot be effectively controlled, the abdomen is opened.

2. Uterine injury or perforation

It often occurs in cases of improper surgical operation or placental implantation. It has been seen that some midwives use the cervix as a placenta and tear off the anterior wall of the vagina to cause severe urinary fistula. Uterine perforation is small, and uterine contractions and antibiotics can be used for close observation when the bleeding is small. Patients with severe uterine injury or bleeding should open for exploration and repair or resection.

3. Postpartum infection

After stripping the placenta with bare hands, antibiotics should be routinely administered, and the appearance of infection signs should be closely observed.