Placental retention
| Classification according to ICD-10 | |
|---|---|
| O73 | Retention of the placenta and membranes without bleeding |
| O73.0 | Retention of the placenta without bleeding |
| O73.1 | Retention of placenta or skin remnants without bleeding |
| ICD-10 online (WHO version 2019) | |
As retained placenta ( lat. Retentio placentae ) in which it is obstetrics the Nichtausstoßung, comportment of the placenta , or any part thereof, called after birth. It occurs in about 1 in 300 births. In veterinary medicine , this is called retentio secundinarum ( postpartum retention ).
causes
The retention of the placenta can have functional and pathological-anatomical causes (implantation disorders).
On the one hand, a spasm of the internal cervix can prevent placenta and membranes from being expelled. The placenta is "pinched" and therefore also called placenta incarcerata .
Another reason for a delayed or no afterbirth can be a failure of the placenta to loosen from the uterine wall. Inadequate shear forces with too little uterine contraction, as well as with too small an attack surface due to a small placenta or placenta membranacea, can lead to the failure of the properly adhering placenta to loosen. In addition, the decidua basalis may lack the thin cancellous layer. This leads to the placenta adherent .
Finally, adhesions between the placenta and uterine wall can be other causes of placental retention. These are implantation disorders, such as the placenta accreta in various forms.
Symptoms
The signs of placental rupture appear differently. While the signs become positive with the trapped placenta, they remain negative with the other forms. In addition, it can lead to increased bleeding from the uterus, as it cannot contract sufficiently when the plazanta is in place. Another danger, if the placenta is not cleared, are infections ( endometritis ), which can develop into septicemia and thus into a life-threatening condition.
treatment
Medications that promote labor cause the uterus to contract and help the placenta to dissolve. Emptying the urinary bladder, gently rubbing the uterus, and a brief cold stimulus also promote the contraction of the uterus. If necessary, the Credé handle can also be used.
In placenta incarcerata , antispasmodic agents can dissolve the spasm.
If these measures are unsuccessful, as with the other forms, manual placental detachment under anesthesia is necessary.
In extreme cases of placenta increta / percreta, it may be necessary to remove the uterus because parts of the placenta cannot be removed.
literature
- Willibald Pschyrembel , Joachim Dudenhausen : Practical obstetrics . Walter de Gruyter, 17th edition, Berlin 1991, ISBN 3110128810 , p. 602 ff.
- Joachim Dudenhausen : gynecology and obstetrics. Walter de Gruyter, 2002, ISBN 3110165627 , p. 313
