Gynecology And Obstetrics-

Placental detachment after childbirth

introduction

The placenta, also known as placenta, develops on the lining of the uterus during pregnancy and establishes the connection between mother and fetus via the umbilical cord.
It is very well supplied with blood and provides the unborn child with all the important nutrients and oxygen.

After birth, the placenta is no longer needed, so it detaches from the uterus and is expelled as a so-called afterbirth.

When does the placenta usually occur after the birth?

The uterus contracts (this is called labor) at regular intervals during delivery. This is triggered by the hormone prostaglandin, which is released in high doses towards the end of pregnancy.
As the surface of the uterine lining becomes smaller, the placenta is gradually detached.

By about 30 minutes after the birth, the placenta should have completely loosened and expelled. Otherwise the obstetrician must help mechanically or manually.

Also read:

Birth process
initiate birth
What types of labor are there?

What if the placenta doesn't come off on its own?

The placenta is very rich in blood vessels. If the placenta does not loosen or if parts of the uterus with blood supply remain, this can lead to significant bleeding.

Placental remnants that have not been expelled can also become inflamed and cause so-called postpartum fever. Both of these can develop into serious complications that can lead to death. The afterbirth must therefore be checked for completeness.

If this is not the case, the placenta remains or even the entire placenta must be manually removed from the uterus.
You go with a finger over the vagina into the uterus and feel the place where the placenta has already loosened. With the second hand you press from the outside above on the uterus and push the uterus further downwards. The placenta is fully felt and peeled off with the finger in order to then be pulled out through the vagina.
Afterwards, a curette can be used to feel it and tissue and blood residues can be scraped off.

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Is placental detachment painful?

The placental detachment and afterbirth are usually not painful. Even if the uterus continues to contract, as it does in labor, these afterbirth pains are very gentle and do not cause pain.

Women hardly notice the expulsion of the placenta either, since the birth canal is already pre-stretched.

If the afterbirth contractions are not sufficient, the woman can press something herself and accelerate the expulsion or an agent that promotes labor (oxytocin) can be administered. This, too, is usually not painful.

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Birth pains
Medication to promote labor

Duration of placental detachment

Placental detachment and afterbirth usually take between 10-20 minutes.

If it takes longer than 30 minutes, the placenta / placenta residues should be removed manually from the uterus to avoid major blood loss. In principle, however, you should wait as long as possible to see whether the afterbirth does not resolve itself.

If there is no relevant secondary bleeding, you can wait a little longer for a natural placenta detachment.
Any manipulation carries the risk of incomplete placenta detachment with additional bleeding. Sometimes, however, it cannot be avoided, since residues of the placenta must under no circumstances remain in the woman's body

How much blood loss do you have to expect when the placenta is detached?

With a normal afterbirth, the woman usually loses 250-500ml of blood, anything beyond that is called rebleeding.

The loss of blood in a normal afterbirth does not usually cause symptoms and is not dangerous for the mother. However, if there is an increased blood loss of over 500ml, complications such as

Circulatory fluctuations,
Racing heart or
in severe cases shock can occur.

How can you accelerate placental birth?

Women can promote the afterbirth by pushing at the same time as they did during the previous birth of the child.

Circular movements of the pelvis when kneeling or climbing stairs can also help expel the placenta.

Warm baths or showers can also be successful.

A slight pull on the umbilical cord by an experienced midwife or obstetrician may release the placenta. However, this always harbors the risk of incomplete placenta detachment with bleeding.

What can the doctor do about the placenta detachment?

Oxytocin is a popular drug that is almost always given after birth or after the cord has been cut. This is a synthetically produced endogenous hormone that causes the uterine muscles to contract and thus promotes the detachment of the placenta and hemostasis.
Usually 3-6 units are administered via the vein immediately after the cord is cut.

There are also various postpartum handles.
The most common method is the so-called Baer handle. It should only be used if certain signs of placenta can be seen. During this maneuver, the doctor massages the uterus over the abdominal wall. A contraction is assisted by simultaneously pressing the uterus downwards. At the same time, the umbilical cord can be easily pulled.
However, this should only be carried out if a rapid afterbirth due to major bleeding is desired.

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