Manual separation of the placenta after childbirth - “No one is immune from this! THIS happened to me twice! Manual separation of the placenta, placenta accreta. Manual cleaning of the uterus."

All this is very unpleasant and painful for mom. When you have already given birth to a wonderful child, you find out that it is not the end yet, that intervention is required, and even under general anesthesia! Each mother then, subsequently, looks for the reasons why this happened to me.

When everything happened, probable causes immediately began pouring in from friends and relatives:

you didn't move much!
you moved a lot!
you caught a cold during pregnancy!
you went to the bathhouse during pregnancy! You were overheating!
You probably drank alcohol!

Oh, what nonsense... I moved as usual, never got sick, didn’t visit bathhouses, beaches, and certainly didn’t drink any alcohol. I had no abortions and no scarring on my uterus!

But it happened.

I don’t remember that birth very well at all.. Everything was so terrible and painful, and when my son finally came out, it was a relief! Just every second! It hurts, it hurts, it hurts! it doesn't hurt! Hooray! Happiness! Come on, show me this happiness!

AND such a little thing as a placenta, generally interested me little. The main thing is that THIS HELL is behind me, and my child is healthy and next to me.

But half an hour passed and there was no placenta. I don’t care, but the doctors look at each other, force me to “work my stomach”, then they pull the umbilical cord, and... wow! - the umbilical cord came off, and I was left with the placenta inside.

It was a long time ago. More than 13 years have passed. Time has erased memories. I don’t even remember whether the doctors warned me about what would happen to me now. Did they give me something to sign? I don't remember!

They took my child away and gave him to his dad.

They put me on an IV. And that’s it, a complete cliff. A dream, just a dream. No hallucinations. I slept and woke up. Nothing hurt anywhere.

According to dad (who was right there in the birth room): “I was holding Sashka, he was sleeping, they stuck their hand into you up to the elbow, you screamed so hard that my ears were blocked, the child, strangely enough, did not wake up.”

- I? Plowshares? Well, it didn’t hurt me at all, I was sleeping. Am I really yelling? What was I yelling? Swear words? I - swear words!!? Are not you lying?

An extremely difficult “recovery” after this whole thing.

For more than a day I just slept, woke up for some feedings, changing clothes, forced myself to drink something and go back to sleep, sleep...

Three days later - a control ultrasound of the uterus, everything is clear.

At home, later, for about a month, I could not come to my senses. Sleeping until noon is common. If you suddenly have to get up early, you get terrible dizziness. Perhaps this is a consequence not only of this procedure, but of childbirth in general. I don't know..

I read about the reasons, and even reproached myself. I also read that if this happened once, then with a high degree of probability it will happen again. I haven't been pregnant for 10 years. I didn’t want to repeat the horror of childbirth again.

When I became pregnant again, at every ultrasound I tortured the doctor with the placenta, is it visible or not? Has it suddenly grown back? The doctors said out loud that this could not be determined by ultrasound and everything would be known only on the day of birth.

Well, then we’ll wait for a miracle. Suddenly it will pass.

The second birth was much easier and faster, I was so happy with my daughter that I even forgot that it was time to start" worry about the placenta".

Therefore, the doctor’s words were a complete surprise to me: “the placenta is intact, everything is fine.” How is everything good? She went out? Herself? When? I didn't even notice!!!

And there were also third births.

Inspired by the success of the placenta being delivered during the second birth, I forced myself to believe that everything would be fine, that the placenta would not accrete and would come out on its own, just like the last time.

And she really came out! Herself. Not right away, I had to work and push her to the exit, she came out after 40 minutes.

But anyway, third births are also relevant to this topic. Unfortunately.

In the ward, a few hours after giving birth, I began to experience severe uterine bleeding. They took me back to the maternity ward, saying that now they would do a manual cleaning of the uterus.

Remembering my terrible “departure”, I was very upset, almost to the point of tears. But there is nothing to be done, this is a dangerous matter, and the doctors know better.

They put me on an IV. The whole procedure does not last long. 15 minutes.

I don’t know what medicine they gave me for anesthesia, but it seemed to me that It's been an eternity. The most vivid impressions of the third birth were this general anesthesia.

I still remember everything so clearly.

I, a small piece of a large kaleidoscope, spin and spin, making various beautiful patterns to delight someone’s invisible eyes. So I poured a droplet into a blue stream, now I turned into a petal of a beautiful flower... And everything would be fine, but I (a small part) is oppressed by the feeling “what, this is my life? After all, I came here for something important!? I don’t remember why, but I definitely had a different goal! Why am I spinning around here, where I took a wrong turn."

and all this for a very, very, very long time, until finally a bright light appeared, and people began to speak in low, drawling voices, like in a slow-motion record, and then everything finally fell into place, and then I I remembered about my newborn truly great goal, and realizing this was simply unrealistic happiness!

The relatively high incidence of morbidity after manual separation of the placenta has prompted a desire to narrow the indications for this operation and impose requirements for strict adherence to antiseptic rules and for the correct technical implementation of this operation.

When the operator's hand is passed through the vagina, which may contain various and often pathogenic microorganisms, aseptic conditions are undoubtedly violated. Detailed research by A. A. Smorodintsev showed that the place of greatest accumulation of bacteria is the external genitalia; in the depths of the vagina, towards the os of the uterus, the bacterial flora decreases. This circumstance confirms the need for thorough disinfection of the external genitalia.

To prevent infection in the uterus, Ragosa suggested using a rubber sleeve (a long, fingerless glove). After inserting the hand through the vagina, the sleeve is moved outward, and the hand enters the uterus without touching the walls of the vagina. This proposal, in theory very ingenious and logically sound, is practically difficult to implement due to the technical inconvenience of passing a hand in a rubber sleeve through the vagina.

More convenient is the sleeve made of thin, dense, soft calico proposed by L. L. Okinchits. Use a sleeve of such length that its upper end extends beyond the elbow; the fingers located at the lower end of the sleeve grab it into the folds. The sleeve thus becomes a blind pouch, which is held until the arm reaches the cervix; after this, the sleeve is pulled back and the freed fingers are inserted into the uterus (Fig. 108). The sleeve must be sterile. To make it easier to slide, moisten it with Lysol or Vaseline oil. According to A. Krasnopolskaya, when using the Okinchitsa sleeve, the percentage of febrile postpartum diseases after manual separation of the placenta is reduced by half; The mortality rate is also significantly reduced. The inconvenience of the sleeve lies in the difficulty of moving the hand along the vagina.

Rice. 108. Manual separation of the placenta using the Okinchitsa sleeve.
a - 1st moment (passing the hand through the vagina); C - 2nd moment (insertion of the hand into the uterine cavity); c - 3rd moment (manual separation of the placenta).

To avoid contact of the hand inserted into the uterine cavity with the walls of the vagina, some authors suggest grasping the cervix with bullet forceps and pulling it out of the genital slit. However, this method cannot be recommended, since the area of the greatest accumulation of microbes is precisely the area of the vaginal vestibule. In addition, it is not always easy to pull the neck out of the genital slit without causing damage. V.V. Preobrazhensky recommended separating the placenta with a hand covered with placenta membranes. However, despite all the feasibility, this method is technically difficult to implement. R.V. Kiparsky’s proposal to use sterile petroleum jelly or vegetable oil during intrauterine manipulations, which is generously lubricated with the dorsum of the hand before inserting the hand into the vaginal tube, is justified and easily implemented; bacteria, along with excess petroleum jelly, remain at the vaginal opening and are not carried into the uterine cavity.

The end of the umbilical cord hanging outward during manual separation of the placenta is usually retracted into the vagina, therefore, in order to prevent infection from entering the uterus, it is recommended, as mentioned above, to cut it off before the operation. In recent years, statements have appeared in the obstetric literature in favor of introducing into practice the instrumental method of separation and release of the placenta (P. A. Guzikov) followed by curettage of the uterine cavity (M. L. Vydrin).

With the instrumental method, the possibility of introducing infection into the uterus is sharply reduced, but the possibility of injury to the soft tissue of the uterus certainly increases.

In cases of prolonged delay of the placenta, when there is no bleeding, but there are signs of severe infection (high temperature, rapid pulse, chills, etc.), there should be no rush to manually separate the placenta. Abstaining from intervention will bring more benefit to the patient than active intervention, be it manual or instrumental removal of the placenta, since the operation disrupts the integrity of the granulation shaft in the uterus and thereby weakens the body's local defenses.

In such cases, the doctor should direct all his attention to increasing the overall resistance of the body and maintaining the proper functioning of the internal organs, in particular the activity of the heart.

In order to disinfect the lower part of the birth canal, it is advisable to perform periodic infusions of rivanol or streptocide into the vagina.

If there is severe, life-threatening bleeding, you cannot delay removing the placenta; in some cases, even removal of the uterus along with the placenta is permissible.

Thus, the indication for manual separation of the placenta may be, firstly, bleeding from the uterus when the entire placenta or its individual parts are retained after unsuccessful use of other methods of their removal, and secondly, a long-term retention of the placenta in the absence of bleeding, but with unsuccessful removal his external techniques.

The issue of manual separation of the placenta has to be decided depending on the amount of blood lost and the general condition of the woman in labor.

It is necessary to distinguish: a) manual separation of the placentae (separatio placentae manualis); b) manual extraction of the placenta (extractio placentae manualis); c) manual examination of the uterus (revisio uteri manualis). In the first case, we are talking about the separation of the placenta, which has not yet separated (partially or completely) from the walls of the uterus; in the second case - about the removal of the placenta that has already separated, but has not been released due to hypotension of the uterus, abdominal covers or spastic contraction of the uterine walls. The first operation is more difficult and is accompanied by a known danger of infection of the woman in labor compared to manual examination of the uterus. Manual examination of the uterus refers to an intervention undertaken to locate, separate and remove retained placenta or to monitor the uterine cavity, which is usually necessary after difficult rotation, application of obstetric forceps or embryotomy.

Indications for manual separation of placenta

1) bleeding in the third stage of labor, affecting the general condition of the woman in labor, blood pressure and pulse; 2) delay in the release of the placenta for more than 2 hours and the failure of using pituitrin, taking Crede without anesthesia and under anesthesia. For manual separation of the placenta, inhalation anesthesia or intravenous administration of epontol is used. The woman in labor is placed on the operating table or on a transverse bed and carefully prepared. The obstetrician washes his hands up to the elbows with diocide or according to Kochergin - Spasokukotsky. Technique of the operation. The obstetrician lubricates one hand with sterile Vaseline oil, folds the hand of one hand into a cone and, spreading the labia with fingers I and II of the other hand, inserts the hand into the vagina and uterus. For orientation, the obstetrician leads his hand along the umbilical cord, and then, approaching the placenta, goes to its edge (usually already partially separated).

Having determined the edge of the placenta and starting to separate it, the obstetrician massages the uterus with the outer hand in order to contract it, and with the inner hand, going from the edge of the placenta, separates the placenta with a sawtooth movement (Fig. 289). Having separated the placenta, the obstetrician, without removing his hand, with the other hand, carefully pulling the umbilical cord, removes the placenta. Secondary insertion of the hand into the uterus is extremely undesirable, as it increases the risk of infection. The hand should be removed from the uterus only when the obstetrician is convinced that the removed placenta is intact. Manual removal of the already separated placenta (if external methods are unsuccessful) is also performed under deep anesthesia; this operation is much simpler and gives better results.

Rice. 289. Manual separation of the placenta.

Manual examination of the uterine cavity

Indications for surgery: I) retention of lobules or parts of lobules of the placenta, doubt about its integrity, regardless of the presence or absence of bleeding; 2) bleeding in the presence of retention of all membranes; 3) after such obstetric operations as embryotomy, external-internal rotation, application of abdominal forceps, if the last two operations were technically difficult. Manual examination of the uterine cavity in cases of retained placental lobes or doubts about their integrity is certainly indicated, since retained placental lobules threaten bleeding and infection. The prognosis is worse the later after birth the intervention is performed. Manual examination of the uterus (as well as examination of the cervix using mirrors) is indicated after all difficult vaginal operations in order to timely identify (or exclude) rupture of the uterus, vaginal vaults, and cervix. When manually examining the uterus, it is necessary to remember the possibility of error due to the fact that the obstetrician poorly examines the side of the uterus that is adjacent to the dorsum of his hand (the left side when inserting the right hand, the right side when inserting the left hand). To prevent such a very dangerous mistake and conduct a detailed examination of the entire inner surface of the uterus, it is necessary to perform an appropriate circular rotation of the hand during the operation. Manual separation of the placenta (to a lesser extent, manual examination of the uterus) is still a serious intervention, although the frequency of complications after this operation is significant decreased. However, the enormous danger that threatens the mother not only if she refuses this operation, but also if she delays the manual separation of the placenta, requires every doctor and midwife to master it. Obstetric hemorrhage is a pathology in which emergency care is not only the responsibility of every doctor regardless of his experience and specialty, but also midwives.

Instrumental examination of the uterine cavity

Indications for uterine curettage are delayed lobules or doubts about the integrity of the placenta. This operation has individual supporters. However, our data on its immediate and long-term results indicate the need for a more careful manual examination of the uterine cavity. If there is a suspicion of retention of a lobule in the uterus in those days of the postpartum period, when the uterus has already sharply decreased in size, curettage is indicated.

All operations involving the insertion of a hand into the uterine cavity pose a great danger to a woman’s health. This danger is associated with the possibility of the operator’s hand introducing pathogenic microbes into the uterine cavity. The operation of manual separation of the placenta is especially dangerous in this regard, since during its implementation the operator’s hand comes into contact with the blood and lymphatic vessels of the placental site. Of all women who die from postpartum septic diseases, 20% had manual separation of the placenta or manual examination of the uterine cavity. In this regard, all operations involving the insertion of a hand into the uterine cavity require strict adherence to the indications for their use, strict asepsis during the operation, mandatory and immediate replacement of blood loss and the prescription of antibacterial therapy.

Indications for manual separation of the placenta are bleeding in the afterbirth period in the absence of signs of placental separation and absence of signs of placenta separation an hour after birth of the fetus in the absence of bleeding.

The operation of manual separation of the placenta should be performed in the small operating room of the maternity ward. In the absence of such a room or in case of intense bleeding, the operation is performed on the delivery bed. The woman in labor is placed with her sacrum on the edge of the operating table or a moved Rakhmanov bed. The lower limbs, bent at the knee and hip joints and widely separated, are held using an Ott leg holder (Fig. 36), sheets (Fig. 37) or leg holders of the operating table.

36. Ott leg support.
a - in a disassembled state; b - in working position.

37. Leg support made from a sheet.
a - folding the sheet diagonally; b - twisting the sheet; c - use as a leg holder.

The operation of manual separation of the placenta should be performed under anesthesia, but in conditions where one midwife works independently, the operation must be performed without anesthesia, using 2 ml of a 1% pantopon solution or morphine for pain relief.

The external genitalia and inner thighs of the woman in labor are treated with an antiseptic solution, dried and lubricated with a 5% iodine tincture solution. A sterile diaper is placed under the woman in labor, and the lower limbs and abdomen are also covered with sterile linen. The operator thoroughly washes his hands up to the elbow using any of the available methods (Spasokukotsky, Furbringer, Alfeld, diacid solution, pervomur, etc.), puts on a sterile gown and, before inserting the hand into the uterus, treats the hand and the entire forearm with a 5% iodine solution.

With his left hand, the operator lightly presses through the abdominal wall onto the fundus of the uterus to bring the cervix down to the entrance to the vagina and fixes the uterus in this position. This technique, easily performed after the baby is born, allows the right hand to be inserted directly into the uterine cavity, bypassing the vagina, thereby reducing the possibility of contamination of the hand with vaginal flora. The hand is inserted folded into a cone (“obstetrician’s hand”). A landmark that helps find the placenta in the uterine cavity is the umbilical cord. Therefore, when inserting your hand into the uterine cavity, you must hold the umbilical cord. Having reached the place where the umbilical cord attaches to the placenta, you need to find the edge of the placenta and insert your hand between the placenta and the wall of the uterus. The placenta is separated in a saw-tooth motion. At the same time, the outer hand constantly helps the inner one, fixing the uterus. After the placenta is separated, it is removed with the left hand by pulling the umbilical cord. The right hand should remain in the uterus, so that after removing the placenta, once again carefully check and examine the entire uterus and make sure that the entire placenta has been removed. The well-contracted uterus clasps the hand located in its cavity. The walls of the uterus are smooth with the exception of the placental area, the surface of which is rough. After the operation is completed, uterine contractions are applied, and an ice pack is placed on the lower abdomen.

The process of separation of the placenta usually occurs without any particular difficulties. With true placenta accreta, it is not possible to separate it from the uterine wall. The slightest attempt at separation is accompanied by severe bleeding. Therefore, as already mentioned, if a true placenta accreta is detected, the attempt to separate the placenta must be stopped immediately and doctors must be called to perform a transsection operation. If the bleeding is severe, then the midwife working independently must apply uterine tamponade before the medical team arrives. This temporary measure reduces blood loss only if a tight uterine tamponade is performed, which compresses the vessels of the placental area. Tamponade can be done by hand, or you can use a forceps or tweezers. To tightly fill the uterus, at least 20 m of wide sterile bandage is required.

A woman’s body is created by nature so that she can conceive, bear and give birth to healthy offspring. Every step along the path of this miracle is “thought out” to the smallest detail. So, to provide the baby with everything necessary for 9 months, a special organ is formed - the placenta. She grows, develops and is born just like a baby. Many women who are just about to give birth to a child ask about what an afterbirth is. It is this question that will be answered below.

Development of the placenta

The fertilized egg travels from the fallopian tube to the uterus before becoming an embryo and then a fetus. Approximately 7 days after fertilization, it reaches the uterus and implants into its wall. This process involves the release of special substances - enzymes, which make a small area of the uterine mucosa loose enough so that the zygote can settle there and begin its development as an embryo.

A feature of the first days of embryo development is the formation of structural tissues - chorion, amnion and allantois. Chorion is villous tissue that connects to the lacunae formed at the site of destruction of the uterine mucosa and filled with maternal blood. It is with the help of these outgrowths-villi that the embryo receives from the mother all the substances important and necessary for its full development. The chorion develops over 3-6 weeks, gradually degenerating into the placenta. This process is called "placentation".

Over time, the tissues of the embryonic membranes develop into important components of a healthy pregnancy: the chorion becomes the placenta, the amnion becomes the fetal sac (vesicle). By the time the placenta is almost completely formed, it becomes like a cake - it has a fairly thick middle and thinner edges. This important organ is fully formed by the 16th week of pregnancy, and together with the fetus it continues to grow and develop, properly providing for its changing needs. Experts call this entire process “maturation.” Moreover, it is an important characteristic of pregnancy health.

The maturity of the placenta is determined by performing an ultrasound examination, which shows its thickness and the amount of calcium in it. The doctor correlates these indicators with the duration of pregnancy. And if the placenta is the most important organ in the development of the fetus, then what is the placenta? This is a mature placenta that has fulfilled all its functions and is born after the child.

Structure of the containment shell

In the vast majority of cases, the placenta forms along the posterior wall of the uterus. Tissues such as cytotrophoblast and endometrium take part in its origin. The placenta itself consists of several layers that play a separate histological role. These membranes can be divided into maternal and fetal - between them there is the so-called basal decidua, which has special depressions filled with the mother's blood and is divided into 15-20 cotyledons. These components of the placenta have a main branch formed from the umbilical blood vessels of the fetus, connecting with the chorionic villi. It is thanks to this barrier that the child’s blood and the mother’s blood do not interact with each other. All metabolic processes occur according to the principle of active transport, diffusion and osmosis.

The placenta, and, therefore, the placenta that is rejected after childbirth, has a multilayer structure. It consists of a layer of fetal vascular endothelial cells, then there is a basement membrane, connective pericapillary tissue with a loose structure, the next layer is the trophoblast basement membrane, as well as layers of syncytiotrophoblast and cytotrophoblast. Experts define the afterbirth and placenta as a single organ at different stages of its development, formed only in the body of a pregnant woman.

Functions of the placenta

The afterbirth, which is born some time after the birth of the child, carries an important functional load. After all, the placenta is precisely the organ that protects the fetus from negative factors. Experts define its functional role as a hematoplacental barrier. The multilayer structure of this “cake”, connecting the growing, developing fetus and the mother’s body, makes it possible to successfully protect the baby from pathologically dangerous substances, as well as viruses and bacteria, but at the same time, through the placenta, the child receives nutritional components and oxygen and through it gets rid of products of their vital activity. From the moment of conception and a little longer after childbirth - this is the “life path” of the placenta. From the very beginning, it protects future life, going through several stages of development - from the chorionic membrane to the placenta.

The placenta exchanges not only useful, but also waste substances between mother and child. The baby's waste products first enter the mother's blood through the placenta, and from there they are excreted through the kidneys.

Another functional responsibility of this pregnancy organ is immune defense. In the first months of a fetus’s life, the mother’s immunity is the basis of its health. nascent life uses the mother's antibodies for protection. At the same time, maternal immune cells, which can react to the fetus as a foreign organism and cause its rejection, are retained by the placenta.

During pregnancy, another organ appears in a woman’s body that produces enzymes and hormones. This is the placenta. It produces hormones such as human chorionic gonadotropin (hCG), progesterone, estrogens, mineralocorticoids, placental lactogen, somatomammotropin. They are all important for the proper development of pregnancy and childbirth. One of the regularly checked indicators throughout all months of bearing a child is the level of the hormone estriol; its decrease indicates problems with the placenta and a potential threat to the fetus.

Placental enzymes are necessary for many functions, according to which they are divided into the following groups:

respiratory enzymes, which include NAD and NADP diaphorases, dehydrogenases, oxidases, catalase;
enzymes of carbohydrate metabolism - diastase, invertase, lactase, carboxylase, cocarboxylase;
aminopeptidase A, involved in reducing the vascular pressor response to angiotensin II during chronic intrauterine fetal hypoxia;
cystine aminopeptidase (CAP) is an active participant in maintaining the blood pressure of the expectant mother at a normal level throughout the entire period of pregnancy;
cathepsins help the fertilized egg implant into the uterine wall and also regulate protein metabolism;
aminopeptidases are involved in the exchange of vasoactive peptides, preventing the narrowing of placental blood vessels and participating in the redistribution of fetoplacental blood flow during fetal hypoxia.

The hormones and enzymes produced by the placenta change throughout pregnancy, helping the woman’s body withstand serious stress and the fetus to grow and develop. A natural birth or cesarean section will always be fully completed only when everything that helped the baby grow is removed from the woman’s body - the placenta and membranes, in other words, the afterbirth.

Where is the children's seat located?

The placenta can be located on the wall of the uterus in any way, although its location in the upper part (the so-called fundus of the uterus) of the posterior wall is considered classic and absolutely correct. If the placenta is located below and even almost reaches the os of the uterus, then experts speak of a lower location. If an ultrasound showed a low position of the placenta in the middle of pregnancy, this does not mean at all that it will remain in the same place closer to childbirth. Placenta movement is recorded quite often - in 1 out of 10 cases. This change is called placental migration, although in fact the placenta does not move along the walls of the uterus, since it is tightly attached to it. This shift occurs due to the stretching of the uterus itself, the tissues seem to move upward, which allows the placenta to take the correct upper position. Those women who undergo regular ultrasound examinations can see for themselves that the placenta is migrating from the lower to the upper location.

In some cases, with ultrasound it becomes clear that it is blocking the entrance to the uterus, then the specialist diagnoses placenta previa, and the woman is taken under special control. This is due to the fact that the placenta itself, although it grows in size along with the fetus, its tissues cannot stretch much. Therefore, when the uterus expands for the growth of the fetus, the baby's place may detach and bleeding will begin. The danger of this condition is that it is never accompanied by pain, and a woman may not even notice the problem at first, for example, during sleep. Placental abruption is dangerous for both the fetus and the pregnant woman. Once started, placental bleeding can recur at any time, which requires placing the pregnant woman in a hospital under the constant supervision of professionals.

Why is placental diagnosis needed?

Since the correct development of the fetus, as well as the condition of the pregnant woman, largely depend on the placenta, close attention is paid to it during examinations. An ultrasound examination of pregnancy allows the doctor to assess the location of the placenta and the features of its development throughout the entire period of gestation.

Also, the condition of the placenta is assessed by conducting laboratory tests on the amount of placental hormones and the activity of its enzymes, and Doppler ultrasound helps determine the blood flow of each vessel of the fetus, uterus and umbilical cord.

The condition of the placenta also plays an important role in the most crucial period - the period of childbirth, because it remains the only opportunity for the baby passing through the birth canal to receive all the substances and oxygen he needs. And that is why natural childbirth must end with the birth of a placenta that has fulfilled its functions.

Natural childbirth in three stages

If a woman gives birth naturally, then specialists divide such childbirth into three stages:

period of contractions;
period of pushing;
birth of placenta.

The placenta is one of the most important biological elements throughout pregnancy until the birth of a new person. The baby was born, a “cake” of several layers of different types of tissue and blood vessels played its role. Now the woman’s body needs to get rid of it in order to continue functioning normally in its new status. That is why the birth of the placenta and membranes is separated into a separate, third stage of labor - the departure of the placenta.

In the classic version, this stage is almost painless; only weak contractions can remind the woman that childbirth has not yet completed completely - the postpartum placenta has separated from the walls of the uterus and must be pushed out of the body. In some cases, contractions are not felt at all, but the separation of the placenta can be determined visually: the fundus of the uterus rises above the navel of the woman in labor, shifting to the right side. If the midwife presses with the edge of her hand just above the womb, the uterus is raised higher, but the umbilical cord, which is still attached to the placenta, is not retracted. The woman needs to push, which leads to the birth of the placenta. Methods for isolating the placenta during the postpartum period help to complete the pregnancy correctly, without pathological consequences.

What does the afterbirth look like?

So what is afterbirth? It is a rounded flat formation of a spongy structure. It has been noted that with the body weight of a born child being 3300-3400 grams, the weight of the placenta is half a kilogram, and the dimensions reach 15-25 centimeters in diameter and 3-4 centimeters in thickness.

The afterbirth after childbirth is the object of careful study, both visual and laboratory. A doctor examining this vital organ of the fetus in the womb should see a solid structure with two surfaces - maternal and fetal. The placenta on the fetal side has an umbilical cord in the middle, and its surface is covered with amnion - a grayish membrane with a smooth, shiny texture. Upon visual inspection, you can notice that blood vessels radiate from the umbilical cord. On the reverse side, the afterbirth has a lobed structure and a dark brown tint of the shell.

When childbirth is completed completely, no pathological processes have opened, the uterus contracts, decreasing in size, its structure becomes denser, and its location changes.

Pathologies of the placenta

In some cases, at the last stage of labor, the placenta is retained. The period when a doctor makes such a diagnosis lasts from 30-60 minutes. After this period, medical personnel attempt to release the placenta by stimulating the uterus with massage. Partial, complete accretion or tight attachment of the placenta to the wall of the uterus does not allow the placenta to separate naturally. In this case, specialists decide to separate it manually or surgically. Such manipulations are performed under general anesthesia. Moreover, complete fusion of the placenta and the uterus can be resolved in the only way - removal of the uterus.

After childbirth, the placenta is examined by a doctor, and if damage or defects are found, especially if the woman in labor continues to have uterine bleeding, then a so-called cleaning is carried out to remove the remaining parts of the placenta.

Massage for the placenta

In natural childbirth, it is not such a rare problem - the placenta did not come out. What to do in this case? One of the effective and safe methods is massage to stimulate the uterus. Experts have developed many techniques to help a woman in labor get rid of the placenta and membranes without external intervention. These are methods such as:

Abuladze's method is based on gentle massage of the uterus with the aim of contracting it. Having stimulated the uterus until it contracts, the doctor with both hands forms a large longitudinal fold on the peritoneum of the woman in labor, after which she must push. The placenta comes out under the influence of increased intra-abdominal pressure.
Genter's method allows the placenta to be born without any effort on the part of the woman in labor due to manual stimulation of the uterine fundus in the direction from top to bottom, to the center.
According to the Crede-Lazarevich method, the placenta is squeezed out by pressing the doctor on the fundus, anterior and posterior walls of the uterus.

Manual manipulation

Manual separation of the placenta is carried out through internal manipulation - the doctor inserts his hand into the vagina and uterus of the woman in labor and tries to separate the placenta by touch. If this method does not help to remove it, then we can only talk about surgical intervention.

Is there a way to prevent placental pathologies?

What is afterbirth? Gynecologists often hear this question from women. planning motherhood. The answer to this question is both simple and complex at the same time. After all, the placenta is a complex system for maintaining life, health and proper development of the fetus, as well as the health of the mother. And although it appears only during pregnancy, the placenta is still a separate organ, potentially susceptible to various pathologies. And disturbances in the vital functions of the placenta are dangerous for the baby and his mother. But very often the occurrence of placental complications can be prevented by fairly simple, natural methods:

thorough medical examination before conception;
treatment of existing chronic diseases;
a healthy lifestyle with cessation of smoking and alcohol, normalization of work and rest schedules;
introduction of a balanced diet for the expectant mother;
maintaining a positive emotional background in life;
moderate exercise;
walks in the open air;
preventing infection with viral, bacterial and fungal infections;
taking vitamin and mineral complexes recommended by a specialist.

Following these natural tips will help you avoid many problems during pregnancy and childbirth.

So, what is afterbirth? This is a special part of the pregnant woman’s body that ensures conception, gestation and the birth of a new life. This word, which speaks for itself, refers to the placenta and fetal membranes that were born after the child or were forcibly removed and served the most important role - helping in the formation of a new life.