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Case Study
WORLD JOURNAL OF PHARMACEUTICAL
Sathiyalathasarathi. World Journal of Pharmaceutical and Medical Research
ISSN 2455-3301
AND MEDICAL RESEARCH
[Link] WJPMR
OBSTETRICAL EMERGENCY - RETAINED PLACENTA - CASE STUDY
Prof. Sathiyalathasarathi*
HOD, Dept. of Obstetrics and Gynaecological Nursing, Sree Balaji College of Nursing, Chennai-44.
*Corresponding Author: Prof. Sathiyalathasarathi
HOD, Dept. of Obstetrics and Gynaecological Nursing, Sree Balaji College of Nursing, Chennai-44.
Article Received on 11/05/2018 Article Revised on 01/06/2018 Article Accepted on 22/06/2018
ABSTRACT
The retained placenta is a significant cause of maternal mortality and morbidity throughout the developing world.
It complicates 2% of all deliveries and as a case mortality rate of nearly 10% in rural areas. A retained placenta
occurs when all or part of the placenta remains inside the uterus after child birth. Normally, placenta is delivered
within 30 minutes. For some women, the placenta does not deliver naturally due to weak or uncoordinated uterine
action. So the placenta will not able to come on its own. In this case study, soon after delivery, cervical os was
closed and the placenta was retained inside the uterus. She had adherent placenta which has been removed
manually under spinal anaesthesia. The mother and baby recovered by appropriate treatment and care.
KEYWORDS: Retained placenta, Myometrium, haemorrhage, manual removal, trapped placenta, placenta
adherent, and blood transfusion.
INTRODUCTION Women at risk of retained placenta
A Pregnant women over the age of 30 years.
A retained placenta is a potential life threatening
situation. Normally if placenta is delivered, the Having a premature delivery that takes place before
contractibility of the uterus causes the blood vessels 34weeks of gestation.
within it to constrict. If the placenta is retained, the Experiencing an extremely long first and second
uterus is unable to perform this function. If the blood stage of labour.
vessels are not closed off, they continue to bleed. This Delivering a stillborn baby.
may leads to haemorrhage which is one of the serious
obstetrical emergency. Presently, the only effective CASE STUDY OF MRS.X
treatment is manual removal of placenta (MROP) under Mrs.X, 23 years old postnatal mother delivered by
anaesthesia. This needs to be carried out within few normal vaginal delivery with episiotomy. She got
hours of delivery to avoid haemorrhage. admitted with Labour pain, syntocin 5 units in 5%
dextrose was administered. Cervibrim gel (0.5mg) was
Types of Retained Placenta applied. She delivered a male baby, cried immediately
Retained placenta can be broken into three distinct after birth. But the placenta was remain inside and there
classifications: is no signs of placental separation. even after 45 mins of
I. Trapped placenta: The placenta detaches from the birth of the baby, the placenta is not come out and the
uterus but become trapped due to the cervix closing. cervical os is closed and the placenta get retained inside
II. Placental Adherence: Placental adherence occurs the uterus. Under spinal anaesthesia uterus is explored
when the contraction of the uterus are not sufficient and the placenta seem to be adherent. They removed
enough to completely expel the placenta. This result manually in to with entire membranes after carefully
in the placenta remaining loosely attached to the separating the edge of the placenta from the uterine wall.
walls of the uterus. This is the most common type of The episiotomy wound closed in layers. The uterus
retained placenta. contracted well on vaginal bleeding. inj. Methergin 1
III. Placenta Accreta: The placenta attaches to the amp, inj. syntocin 10 units in normal saline was
myometrium (muscular walls) of the uterus, instead administered.
of the uterine wall. So delivery becomes harder and
often results in severe bleeding. Blood transfusion
and even a hysterectomy may be required for this
type of retained placenta.
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Sathiyalathasarathi. World Journal of Pharmaceutical and Medical Research
Fig 1: Manual removal of Placenta (MROP).
Comparision of Signs and symptoms
Book picture Patient picture
Exhaustion and prolonged labour
Atonic uterus
Constriction ring (Hour- glass contraction) Presence of Morbid adhesion of the
Pre mature attempts to deliver the placenta before it is placenta
separated.
Morbid adhesion of the placenta
Signs and symptoms
In this case study, no signs of placental separation of morbid adherent placenta was observed.
Diagnosis
Book picture Patient picture
1. The uterus is felt soft instead of hardness Present
2. No change in the height of the fundus Present
3. By pressure test the loop of cord at vulva becomes indrawn Present
4. on vaginal examination the placenta is not felt lying in the vagina or cervix Present
Management for morbid adherent placenta Complications
Partial type: under General Anaesthesia, adherent part is Post-partum haemorrhage
gently separated by scraping away from uterine wall, Shock
while supporting abdominal wall. oxytocin and blood Puerperal sepsis
transfusion are given. Thrombophlebitis in the pelvis and leg veins
Complete type: placenta is separated and removed as Embolism and risk of recurrence in the next
much as possible, most adherent part is left. If bleeding pregnancy.
is continuing under blood transfusion hysterectomy has
to be performed. Nursing interventions
Potential for shock and collapse related to retained
In this study, the patient is shifted to operation theatre. placenta.
Under general anaesthesia, the placenta has removed by
scrapping from the uterine wall followed by blood Checked the condition, monitored the vital signs, BP
transfusion done. 120/90 mmHg, normal vaginal bleeding, administered
syntocin 10 units with normal saline solution. Inj
methergin 0.2 mg was administered to stimulate uterine
contraction and arrest the bleeding.
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Sathiyalathasarathi. World Journal of Pharmaceutical and Medical Research
CONCLUSION
Retained placenta is one of the reason for post partum
haemorrhage, hence health care professionals take
judicious judgement and appropriate intervention to
prevent dangerous complications of retained placenta.
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