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Manual extraction of the placenta involves putting the obstetrician's hand into the uterine cavity and separating the placenta from the uterine cavity. Difficulty extracting the placenta may indicate a rare pathology - placenta adnate. Due to the large traumatization of the tissues, the procedure is performed under anesthesia.

Manual Removal of the Placentais a term that describes obstetric surgery to remove the placenta from the uterine cavity after delivery. This concept is dedicated to physiological births, when the spontaneous birth of the placenta does not take place after the baby is born. Due to the traumatization of tissues, the procedure is performed under anesthesia. Manual extraction of the placenta is performed in the event of a prolonged third stage of labor and also in cases of intense vaginal bleeding.

Indications for Manual Extraction of the Bearing

The indications for the manual extraction of the placenta are the following clinical situations:

  • haemorrhage immediately after childbirth, without the concomitant process of birth of the placenta. This is a sign of a partial separation of the placenta from the uterine cavity, so there is still a fragment of the placenta that does not separate despite pushing
  • hemorrhage after the birth of an incomplete placenta. The lack of completeness is assessed on the basis of the determination of the absence of placental fragments during visual inspection by a physician.

The above clinical situations result primarily from abnormal contractions of the uterine muscle. The very contraction mechanism performed by the muscles of the uterus seals the tiny blood vessels, which in turn stops excessive bleeding. Therefore, impaired contraction mechanism leads to incomplete contraction of the uterine muscle, which impairs the birth process of the placenta and relatively increases blood loss.

Technique for performing manual bearing extraction

Manual extraction of the placenta is one of the more difficult obstetric procedures. The doctor performing the procedure places one hand above the bottom of the uterus, gently pressing the abdominal wall. The other hand goes through the vagina into the uterine cavity. Then the doctor should locate the umbilical cord and the edge of the placenta. In the next stage, he slides his fingers between the placenta and the uterine wall, trying to gently separate the fused structures. After unsticking all of themthe placenta comes out through the vagina. After removing the placenta, the doctor must check that the complete placenta has been removed and that no fragment remains in the uterine cavity.

Manual extraction of the placenta is a prevention of serious postpartum complications. First of all, it reduces the intensity of bleeding and also prevents pieces of tissue from being left inside the uterine cavity. If the postpartum hemorrhage has not been effectively controlled by the performed procedure, it is recommended to support the contraction of the uterine muscle not only by the administration of appropriate drugs, but also by gentle external massage of the uterine muscle.

Delivery of the placenta during cesarean section

The term manual removal of the placenta is dedicated mainly to physiological deliveries, but during cesarean delivery, we also deal with the delivery of the placenta. Then, the bearing of the placenta proceeds in two mechanisms - spontaneously or with the help of an obstetrician, by manual extraction of the placenta.

It should be emphasized that while in the case of physiological labor, manual extraction of the placenta reduces bleeding and speeds up the delivery, there are no such observations in relation to caesarean section. Consequently, the risk of intrauterine infection is comparable.

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Childbirth