Lectures often Placenta evacuation and postpartum often

2021-03-21 12:00 AM

Placenta membranes are first contracted by uterine contraction and contraction, dislodging the placenta membranes, followed by the weight of the blood clot after the placenta and dilute the blood, the weight of the placenta cake making the remainder of the placenta film.

Outline of placenta often

Placenta evacuation is the 3rd stage of labor, followed by the cervical opening and the term of pregnancy. If the previous 2 stages are normal, the prognosis of pregnant women now depends on the progression of this stage.

Some anatomical features of the uterus and placenta 

The uterine body has 3 layers: sphincter, longitudinal muscle and knitting muscle. The muscular layer is thick and has many blood vessels. The knitting muscle has the ability to contract and contract, and has elasticity.

The placenta has no muscle structure and the elastic fiber has no elastic properties.

The extracellular matrix at the location of the lettuce has 3 layers: the thick layer above, the spongy layer in the middle, with many blood vessels, so the organization is very loose, the placenta peel will peel off in this layer. The bottom layer at the bottom is close to the uterine muscle.

The mesothelioma and the extracellular matrix are connected by placenta spikes attached to the bottom of the blood vessels and separated from the walls of the blood vessels in a solid layer.

Mechanism of peeling placentas

After the pregnancy, the uterus shrinks, the placenta's adhesion area also shrinks, but the placenta is not as elastic as the uterine muscle, so the placenta cake shrinks, thickens, the placenta layer piles out of the placenta area. cling. The smaller the uterus is, the more the placenta cake shrinks and thickens, the more the uterus contracts, making the placenta shrink and pull strongly into the porous layer, the blood vessels in the spongy layer are torn and removed causing bleeding. and forming a blood clot behind the placenta, the clot gets bigger and bigger, the weight of the blood clot behind the placenta loosens the remaining foam of the placenta cake.

Mechanism of peeling off placenta membranes

Placenta membranes are first contracted by uterine contraction and contraction, dislodging the placenta membranes, followed by the weight of the blood clot after the placenta and dilute blood, the weight of the placenta cake making the remainder of the placenta film.

Clinical phenomena in placenta period

Physiological rest period

Placentas are ready to peel or peel, pregnant women feel comfortable and comfortable. The pulse does not change or slightly slows down, the blood pressure is stable, the uterus is at the uterus, about 15 cm above the guard, the density of the uterus is firm. After 10-15 minutes, the uterus contracts more strongly, the woman feels pain again.

The period of placenta peeling and placentas down

Pregnant women feel pain almost at birth, peeling mechanism appears and uterine contractions push placentas and placenta membranes down.

The condition of pregnant women is stable, almost unchanged. The vulva may bleed less, the amount of bleeding depends on the type of placenta book (the blister type is more bleeding than the membrane type). The uterus is taller, up to 18 - 20 cm, but narrow in width, solid density than during sexual rest. Placenta cord will fall out of the vulva. This period lasts 5-10 minutes.

Placenta period

Placentas down the uterus make the lower part bulge up, push the bottom of the uterus up, placentas down to the vagina, the lower placenta membrane will continue to peel off. The uterus is empty, contracting tightly to perform physiological embolism. After forming a safe block, the contractions cease to work, and the woman no longer feels pain. The uterus is about 13 cm above the body.

Vaginal bulging, vulva open and placentas can be seen. If the woman squeezes it, it will make the placentas fall out. That is the type of automatic placenta book.

Types of placenta evacuation

Membrane foam (Baudeloque type)

The placentas begin to peel from the center to the edge of the placenta, the blood clot behind the placenta completely collects behind the placenta cake. Placentas completely peel off and reach the vagina, the placenta membrane surface will turn upside down and run out first and only see bleeding after placentas have completely drained. Ball of this type account for 75% and cause less placenta defects.

Placenta wedges (Duncan style)

Placentas begin to peel from the edge of the placenta cake into the center, blood is gathers behind the placentas, a part separates the placenta membranes to flow out, so during the peeling process, there is a lot of blood flowing through the vagina. When the placentas run out, the extracellular side comes first, then the blood clot behind the placentas and the placenta come out at the same time. This type of ball and placenta is about 25%.

Maternity status and complications after having placentas

The whole woman's status is normal, pulse slowed or unchanged, is clear. Stable blood pressure. Little or no vaginal blood. The uterus shrinks into a safe block.

After the placenta, if the bleeding is more than usual, look for the following reasons:

Sputum of the uterus: the uterus is soft, flabby, enlarged, does not form a safe mass.

Broken uterus, cervical tear.

Vaginal tearing.

Pour placentas.

Placenta evacuation ways

There are 3 ways to book placentas.

Automatic placenta book

All 3 periods of placenta book (drop, down, book) happened naturally, this type of book is not good because it is easy to cause placentas to be missed or missed.

Natural placenta book

Two periods of placenta peeling and placentas down happened naturally, but when the placentas came out, there was the intervention of the midwife to remove the placentas and the placenta film. 

Peel off artificial placentas

After 30 minutes of non-peeling placentas, the physician must put his hand into the uterus to remove the placentas, take the placentas, the placenta film out. After peeling placentas, conduct uterine control immediately.

Handling in the period of placenta evacuation

Follow up the patient

The placenta period lasts about 15-20 minutes. Monitor the whole situation of pregnant women, monitor vaginal bleeding for timely detection and management.

Test for placenta peeling

Before helping placentas, you need to do placenta peeling test to see if placentas are peeling. Have 2 way:

Place the hand side above the hip joint, corresponding to the lower uterine segment, push the uterus upwards, monitoring the placenta cord outside the vulva. If the placenta cord is pulled upwards (stopped), the placenta has not come off the uterus. If the placenta cord remains in the same position or falls low (elongated), the placenta has come off and the placenta has reached the lower part or lying in the vagina. Or when cutting the umbilical cord, pince clamped the placenta cord close to the anus, watching to see that the cord of the umbilical cord became more and more distant from the vagina when the placentas were gone.

Supporting placentas: Only intervening in the period of placentas, which means when placentas have naturally flaky and reach the vagina, actively supporting placentas slowly with the weight of placenta cakes.

Then 1: One hand lifts the umbilical cord clamp to the level of the lying woman, the other hand is placed on the front and bottom of the uterus in the abdominal wall, pushes the uterus back and down toward the subframe to let the placenta cake out.

Then 2: Place the edge of one hand on top of the joint while pressing down, while slowly pushing up towards the breast, holding the other hand to lift the umbilical cord so that the placenta cake slowly falls down to make the placenta membrane peel off. out.

If the placenta film is still not peeling off, use both hands to gently rotate the placenta cake, or use the pince to clamp the placenta film close to the vagina and pull slowly out. In theory, the placenta film remaining less than 1/4 is considered normal.

Check the placentas

The purpose of placenta inspection is not to leave placentas and placenta membranes left behind.

Check the placenta film

Enough placenta membranes: The rupture of the amniotic fluid is a regular round shape.

Check for extra placenta cake: there are blood vessels running from the placenta cake on the surface.

Measure the amniotic membrane from the edge of the placenta cake to the rupture of the amniotic fluid. If the shortest part is less than 10 cm, then the retrospective diagnosis is the placenta striker.

Check the properties and color of the placenta film to see if there is an infection.

Check out the placenta cake

Normally, placenta cakes have 15 - 20 packs of placentas, the face of the placenta is smooth, dark red. The placenta cake is round, regular, thick in the middle and thinner to the edge of the placenta cake, with no blemishes on the placenta segments. If there is a defect in which there is an omission of placentas, the portion of the placenta can be completely lost. Check the shape and size of the placenta cake. The weight of the placenta cake is 1/6 of the weight of the fetus.

Check for a dimple on the surface of the placenta cake due to a blood clot pressed into the young placentas.

Check the placenta cord

White, protruding blood vessels. Length about 40-60 cm. Occasionally, the placenta vine is tied up or twisted.