Retained Placenta

Overview of Retained Placenta

All the stages of labor, third stage is the most crucial one for the mother. Fatal complications may appear unexpectedly in an otherwise uneventful first or second stage. The following are the important complications:

• Postpartum hemorrhage
• Retention of placenta
• Shock—hemorrhagic or non-hemorrhagic
• Pulmonary embolism either by amniotic fluid or by air
• Uterine inversion (rare). [1]

Indian epidemiology then other

Causes of Retained Placenta

There are three phases involved in the normal expulsion of placenta i.e.:

(1) Firstly, Separation through the spongy layer of the decidua

(2) Secondly, Descent into the lower segment and vagina

(3) Finally, its expulsion to outside.

• Interference in any of these physiological processes, results in its retention.
• Placenta completely separated but retained is due to poor voluntary expulsive eff orts.
• Simple adherent placenta is due to uterine atonicity in cases of grand multipara, over distension of uterus, prolonged labor and uterine malformation or due to bigger placental surface area.
• The commonest cause of retention of non-separated placenta is atonic uterus.
• Morbid adherent placenta—partial or rarely, complete.
• Placenta incarcerated following partial or complete separation due to constriction ring (hourglass contraction), premature attempts to deliver the placenta before it is separated.[1]

AAA

Risk factors are things that make you more likely to develop a disease in the first place.

Pathogenesis refers to the development of a disease. It’s the story of how a disease gets started and progresses.

This is the entire journey of a disease, encompassing the cause but going beyond it.

Pathophysiology, on the other hand, focuses on the functional changes that occur in the body due to the disease. It explains how the disease disrupts normal physiological processes and how this disruption leads to the signs and symptoms we see.

Imagine a car accident. Pathogenesis would be like understanding how the accident happened – what caused it, the sequence of events (e.g., one car ran a red light, then hit another car). Pathophysiology would be like understanding the damage caused by the accident – the bent fenders, deployed airbags, and any injuries to the passengers.

In simpler terms, pathogenesis is about the "why" of a disease, while pathophysiology is about the "how" of the disease’s effects.

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Sign & Symptoms of Retained Placenta

Retained placenta can be broadly divided into:

• Failed separation of the placenta from the uterine lining
• Placenta separated from the uterine lining but retained within the uterus. [3]
• Risks of retained placenta include hemorrhage and infection.
• After the placenta is delivered, the uterus should contract down to close off all the blood vessels inside the uterus.
• If the placenta only partially separates, the uterus cannot contract properly, so the blood vessels inside will continue to bleed.
• A retained placenta thereby leads to hemorrhage. (15 minutes) spent following delivery of the baby.
• Features of placental separation are assessed. The hourglass contraction or the nature of adherent placenta (simple or morbid) can only be diagnosed during manual removal. [3]

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Complication of Retained Placenta

DANGERS: The risks involved in prolonged retention of placenta are:

(1) Hemorrhage

(2) Shock is due to—

• Blood loss
• At times unrelated to blood loss, especially when retained more than one hour and
• Frequent attempts of abdominal manipulation to express the placenta out.

(3) Puerperal sepsis

(4) Risk of its recurrence in next pregnancy. [1]

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Treatment of Retained Placenta

PERIOD OF WATCHFUL EXPECTANCY

• During the period of arbitrary time limit of half an hour, the patient is to be watched carefully for evidence of any bleeding, revealed or concealed and to note the signs of separation of placenta.
• The bladder should be emptied using a rubber catheter.
• Any bleeding during the period should be managed as outlined in third stage bleeding. [1]

RETAINED PLACENTA:

• Separated
• Unseparated
• Complicated

Placenta separated and retained—To express the placenta out by controlled cord traction.

Unseparated retained placenta (apparently uncomplicated): Manual removal of placenta is to do under general anesthesia as described earlier.[1]

Drugs, such as intra umbilical or intravenous oxytocin, are often used in the management of placental retention. It is useful ensuring the bladder is empty. However, ergometrine should not give as it causes tonic uterine contractions which may delay placental expulsion. Controlled cord traction has recommended as a second alternative after more than 30 minutes have passed after stimulation of uterine contractions, provided the uterus contract.

Manual extraction may require if cord traction also fails, or if heavy ongoing bleeding occurs. There is currently uncertainty about the effectiveness of anesthesia or analgesia for manual extraction, in terms of pain and the risk of postpartum hemorrhage.

Very rarely a curettage is necessary to ensure that no remnants of the placenta remain (in rare conditions with very adherent placenta such as a placenta accreta).

However, in birth centers and attended home birth environments, it is common for licensed care providers to wait for the placenta’s birth up to 2 hours in some instances.[3]

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Homeopathic Treatment of Retained Placenta

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines for Retained Placenta:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy.

Medicines:

Belladonna

• Heat and dryness of vagina.
• Red face and eyes.
• Profuse flow of bright red blood which speedily coagulates; blood feels hot as it passes through vagina; hour-glass contraction.
• sensations of heat – there may be gushes of blood, red, flushed face, and any sensation of jolting or jarring will upset her greatly.
• The labor is usually quite intense so it may be that she needs to pause and re-group before pushing out the placenta.

Caulophyllum

• Retained placenta from weakness and exhaustion.
• Flooding from inertia of uterus.

Cantharis

• Retained placenta or membranes.
• No expulsive pains; pain or burning while urinating.
• There may be retention of urine.
• Creates an expulsive action – this can also be used for miscarriage when there are no contractions, bleeding or move to expel the baby.

Gelsemium

• Cutting pains in lower part of abdomen running from before backward and upward which retard expulsion of the placenta.

Gossypium

• Retention of placenta which adheres firmly to walls of uterus
  Leading indications.

Ipecac

• Retained placenta with constant flow of bright red blood.
• Pain about navel passing though uterus; constant nausea.
• Labored breathing.

Pulsatilla

• Inertia of uterus, expulsive power wanting.
• When placenta remains attached to walls of uterus; flooding; blood flows and stops and flows again.[2]

China

• Farrington recommends it when retained placenta attend with flooding and Puls.
• Under such circumstances, he used to administer China in repeated doses until the tonicity of uterus restore and then remove the placenta by the aid of the hand.

Secale

• For simple retained placenta; or hour-glass contraction of uterus causing retained placenta.
• With constant strong bearing down; with relaxed feeling of part.

Sepia

• Retained placenta after miscarriage.
• Usually in a woman that has had several pregnancies, may have been a labor that ends with a high level of exhaustion-mentally feeling done – so when it is time to deliver the placenta they literally have very little will left.[2]

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References use for Article Retained Placenta

[1] DC Dutta “TEXT BOOK OF OBSTETRICS”

[2] The Homoeopathic Prescriber By K. C. Bhanja

[3] https://en.wikipedia.org/wiki/Retained_placenta

Frequently Asked Questions

What is Retained Placenta?

The placenta is said to retain when it is not expelling out even 30 minutes after the birth of the baby (WHO 15 minutes).

Homeopathic Medicines used by Homeopathic Doctors in treatment of Retained Placenta?

• Belladonna
• Caulophyllum
• Cantharis
• Gelsemium
• Gossypium
• Ipecac
• Pulsatilla

What causes Retained Placenta?

• Separation through the spongy layer of the decidua
• Descent into the lower segment and vagina
• Finally, its expulsion to outside

What are the symptoms of Retained Placenta?

• Failed separation of the placenta from the uterine lining.
• Placenta separated from the uterine lining but retained within the uterus.
• Risks of retained placenta include hemorrhage and infection.