RETAINED PLACENTA UTERINE INVERSION POSTPARTUM PYREXIA POSTPARTUM HEMORRHAGE (PPH) POSTPARTUM MOOD ALTERATIONS RETAINED PLAC...
- RETAINED PLACENTA
- UTERINE INVERSION
- POSTPARTUM PYREXIA
- POSTPARTUM HEMORRHAGE (PPH)
- POSTPARTUM MOOD ALTERATIONS
- placenta undelivered after 30 minutes (3rd stage)
- risk factors:
- placenta previa,
- prior C/S,
- post-pregnancy curettage,
- prior manual placental removal,
- uterine infection
- placenta separated but not delivered, or abnormal placental implantation
- placenta accreta: placenta adherent to myometrium
- placenta increta: invasion of myometrium
- placenta percreta: invasion of myometrium beyond serosa
- increased risk of infection or bleeding
- management
- 2 large bore IVs, type and screen
- perform Brant maneuver (firm traction on umbilical cord with one hand applying pressure suprapubically to hold uterus in place)
- oxytocin 10 IU in 20 mL NS into umbilical vein
- manual removal if above fails
- D&C if required
UTERINE INVERSION
- uterus prolapses through the cervix and passes out of the vaginal introitus
- often iatrogenic (excess cord traction)
- more common in grand multiparous (lax uterine ligaments)
- urgent management essential (may require general anesthetic if unsuccessful)
- replace uterus without removing placenta
- remove placenta manually and withdraw slowly
- IV oxytocin infusion
- re-explore uterus
