hand placenta removal

Curing disease: Indication 1. After the fetus is delivered through the vagina, the placenta is still unborn for 30 minutes. 2, less than 30 minutes after the delivery of the baby, but the vaginal bleeding has reached 200ml. 3, a history of placental adhesions, or this time for vaginal surgery under general anesthesia, can be removed after the delivery of the baby. Preoperative preparation 1, bladder lithotomy position, disinfection vulva and exposed umbilical cord, remove sterile towel, single, surgeons for sterile gloves and surgical gowns, or wear sterile sleeves outside the original surgical gown. Catheterization. 2, intramuscular injection of pethidine 100mg, intravenous anesthesia or general anesthesia in the tracheal, individual can not give anesthesia, but must be clearly explained to the patient, in order to cooperate. 3, infusion, oxytocin 10U slow intravenous injection, intramuscular injection or injection of the fundus muscle through the abdominal wall. Surgical procedure 1. The surgeon holds the umbilical cord in one hand and the lubricant in the other hand. The five fingers are closed into a cone shape, and enter the vagina and uterine cavity along the umbilical cord to find out the place where the placenta is attached. 2, one hand through the abdominal wall under the pressure of the bottom of the palace, the palm of the hand in the uterine cavity is unfolded, the four fingers are close together, the back of the hand is close to the wall of the palace, and the tip of the finger and the lateral edge of the ankle are swung up and down, and the placenta is peeled off from the wall of the palace. At the beginning, there is a layer of smooth membrane between the finger and the placenta. After the membrane is broken, the finger directly contacts the placenta and the wall of the placenta. Generally, there is no difficulty in peeling off. In case of resistance, it should be carefully peeled off with both hands inside and outside. When a little cable-like adhesive tape is used, it can be disconnected with your fingers. The adhesion surface is wide and tight, and it cannot be peeled off by hand. It may be adhesion or implantation of the placenta. The operation should be stopped immediately. Strengthen uterine contractions, ergometrine 0.2mg intramuscular injection or intravenous injection, if bleeding is not much, you can temporarily observe, give oxytocin. If there is more bleeding, it will be treated with laparotomy. 3. If the placenta is attached to the front wall, the palm is peeled off from the wall by the wall toward the front wall. 4. It is estimated that most of it has been peeled off, and the umbilical cord can be pulled again in one hand to help identify and separate the remaining part, and then hold the placenta in the hand and pull it downward while rotating. Be careful not to use strong traction to avoid residual part of the placenta or membrane. 5, check the placenta and fetal membranes for defects, and reach into the uterine cavity examination, remove residual tissue, can also be grasped with the oval clamp under the guidance of the finger, or scraped with a large blunt curette. Pay attention to check the uterus for damage. complication 1, uterine bleeding It mainly occurs when the placenta is difficult to peel off or the peeling is incomplete, which affects the contraction of the uterus and causes massive bleeding. Experienced people should be asked to complete the operation quickly, remove the contents of the uterus, and strengthen the contractions and control bleeding. Can not effectively control the emergency treatment of laparotomy. 2, uterine injury or perforation It often occurs in cases of improper operation or placenta implantation. I have seen individual birth attendants use the cervix as a placenta and tear off the anterior wall of the vagina to cause severe urinary fistula. The uterus perforation is small, and when there is not much bleeding, it can be closely observed with uterine contractions and antibiotics. Patients with severe uterine injury or bleeding should be opened for exploration and repaired or removed. 3, postpartum infection After removing the placenta by hand, antibiotics should be routinely administered and the signs of infection should be closely observed.