The placenta is a tissue interface in between mother and the developing baby. This placenta allows for uptake of nutrients and exchange of gases, thermo-regulates baby and removes waste from the mother’s blood. It helps fight infections and synthesizes hormones to maintain pregnancy. It supplies both oxygen and nutrients to the baby in the womb and removes waste products from their blood.
The placenta itself is attached to the uterus wall, and the baby’s umbilical cord originates from the placenta and is attached to it. The umbilical cord is the connecting cord between mother and the growing baby.
What is placenta removal ?
Placental expulsion (otherwise known as the afterbirth) is the procedure of placenta coming out of the birth canal after the delivery of baby. This period from immediately after the baby comes out of canal till when the placenta comes out is known as the third stage of labour.
This third stage of labour is either managed actively (active management) with several standard procedures, or it is managed passively or expectantly (physiological or passive management), the latter method allowing for the placenta to be expelled without extra medical assistance.
How does placenta removal occur ?
Placenta removal occurs as a physiological separation from the uterine wall. The placenta is typically expelled within the first 15–30 minutes of the baby’s birth.
At this time, mother’s blood loss can be more, but it is limited by the uterus’s contraction. The amount of blood loss said to be normal is less than 600 ml.
What does active management of placenta removal involve ?
The methods of active management consist of the following.
1) Umbilical cord clamping : Active management usually consists of clamping of the umbilical cord, mostly within seconds to minutes after birth.
2) Uterine contraction : Uterine contraction helps in delivering the placenta and this can be induced with oxytocin via injection or infusion. Ergometrine may also be used, but it can cause nausea, vomiting or hypertension.
Even breastfeeding immediately after birth or massaging the uterus (at its upper portion) also brings about uterine contractions.
3) Cord traction : The third method is the controlled cord traction (CCT) which consists of pulling the umbilical cord while putting counter pressure to assist in delivery of the placenta. This may be somewhat uncomfortable for the mother. This procedure requires specific training. Doing premature cord traction will resulting in pulling the placenta out before its natural detachment from the uterine wall, causing hemorrhage.
What is manual placenta removal ?
This is the evacuation or removal of the placenta from the uterus by the doctor’s hand. It is usually done either anesthesia or sometimes under sedation and painkillers. A hand will have to be inserted all the way into the uterine cavity via the vagina and the placenta is then detached from the uterine wall and removed manually.
What do we mean by retained placenta ?
A retained placenta is in fact a placenta that has not come out of the birth canal within the normal time limits. The risks of retained placenta consist of hemorrhage and infection. When the placenta is not delivered within 30 minutes post child delivery in a hospital, manual extraction will be required or very rarely curettage is indicated to make sure that no remnants of the placenta remain.
Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
