Signs of placental separation. Manual separation of the placenta: methods and techniques

METHODS FOR ISOLATING SEPARATED AFTERMISSION

PURPOSE: To isolate the separated placenta

INDICATIONS: Positive signs of placenta separation and ineffective pushing

ABULADZE METHOD:

Perform a gentle massage of the uterus in order to contract it.

Take with both hands abdominal wall into the longitudinal fold and invite the woman in labor to push. The separated placenta is usually born easily.

CREDET–LAZAREVICH METHOD: (used when Abuladze’s method is ineffective).

Bring the fundus of the uterus to the middle position, and with a light external massage cause the uterus to contract.

Stand to the left of the woman in labor (facing the legs), grasp the fundus of the uterus with your right hand, so that the thumb is on the front wall of the uterus, the palm is on the fundus, and four fingers are on the back surface of the uterus.

Squeeze the placenta: squeeze the uterus anteroposteriorly and at the same time press on its bottom downward and forward along the pelvic axis. With this method, the separated afterbirth easily comes out. If the Credet-Lazarevich method is ineffective, manual separation of the placenta is carried out according to the general rules.

Indications:

no signs of placenta separation within 30 minutes after birth of the fetus,

blood loss exceeding the permissible level

third stage of labor,

· the need for rapid emptying of the uterus in case of previous difficult and operative labor and the histopathic condition of the uterus.

2) start intravenous crystalloid infusion,

3) provide adequate pain relief (short-term intravenous anesthesia (anesthesiologist!

4) tighten the umbilical cord on the clamp,

5) insert a sterile gloved hand along the umbilical cord into the uterus to the placenta,

6) find the edge of the placenta,

7) using a sawing motion, separate the placenta from the uterus (without using excessive force),

8) without removing your hand from the uterus, use your outer hand to remove the placenta from the uterus,

9) after removing the placenta, check the integrity of the placenta,

10) control the walls of the uterus with the hand in the uterus, make sure that the walls of the uterus are intact and that there are no elements of the fertilized egg,

11) do light massage the uterus, if it is not dense enough,

12) remove the hand from the uterus.

Assess the condition of the postpartum woman after surgery.

In case of pathological blood loss it is necessary:

· replenish blood loss.

· carry out measures to eliminate hemorrhagic shock and DIC syndrome (topic: Bleeding in the afterbirth and early postpartum period. Hemorrhagic shock and DIC syndrome).

18. Manual examination of the walls of the uterine cavity

Manual examination of the uterine cavity

1. Preparation for surgery: cleaning the surgeon’s hands, treating the external genitalia and inner thighs with an antiseptic solution. Place sterile pads on the anterior abdominal wall and under the pelvic end of the woman.

2. Anesthesia (nitrous-oxygen mixture or intravenous administration of sombrevin or calypsol).

3. With the left hand, the genital slit is spread, the right hand is inserted into the vagina, and then into the uterus, the walls of the uterus are inspected: if there are remains of the placenta, they are removed.

4. With a hand inserted into the uterine cavity, the remains of the placenta are found and removed. The left hand is located at the fundus of the uterus.

Instrumental examination of the postpartum uterine cavity

A Sims speculum and a lift are inserted into the vagina. The vagina and cervix are treated with an antiseptic solution, the cervix is fixed by the front lip with bullet forceps. A blunt large (Bumon) curette is used to inspect the walls of the uterus: from the fundus of the uterus towards the lower segment. The removed material is sent for histological examination (Fig. 1).

Rice. 1. Instrumental examination of the uterine cavity

TECHNIQUE FOR MANUAL EXAMINATION OF THE UTERINE CAVITY

General information: retention of parts of the placenta in the uterus is a serious complication of childbirth. Its consequence is bleeding, which occurs soon after the birth of the placenta or more late dates. Bleeding can be severe, threatening the life of the postpartum mother. Retained pieces of the placenta also contribute to the development of septic postpartum diseases. In case of hypotonic bleeding, this operation is aimed at stopping the bleeding. In a clinical setting, before surgery, inform the patient about the need and essence of the operation and obtain consent for surgery.

Indications:

1) defect of the placenta or fetal membranes;

2) monitoring the integrity of the uterus after surgical interventions, long labor;

3) hypotonic and atonic bleeding;

4) childbirth in women with a uterine scar.

Workplace equipment:

1) iodine (1% solution of iodonate);

2) cotton balls;

3) forceps;

4) 2 sterile diapers;

6) sterile gloves;

7) catheter;

9) consent form for medical intervention,

10) anesthesia machine,

11) propafol 20 mg,

12) sterile syringes.

Preparatory stage of performing the manipulation.

Execution sequence:

Remove the foot end of Rakhmanov's bed.

Perform bladder catheterization.

Place one sterile diaper under the woman in labor, the second on her stomach.

Treat the external genitalia, inner thighs, perineum and anal area with iodine (1% iodonate solution).

The operations are performed under intravenous anesthesia against the background of inhalation of nitrous oxide and oxygen in a 1: 1 ratio.

Put on an apron, sanitize your hands, put on a sterile mask, gown, and gloves.

The main stage of the manipulation.

With the left hand they spread labia, and the right hand, folded in the form of a cone, is inserted into the vagina and then into the uterine cavity.

The left hand is placed on the anterior abdominal wall and the wall of the uterus from the outside.

Right hand located in the uterus, the walls, placental area, and uterine angles are monitored. If lobules, fragments of the placenta, membranes are found, they are removed by hand

If defects in the walls of the uterus are detected, the hand is removed from the uterine cavity and transection, suturing of the rupture or removal of the uterus (doctor) is performed.

The final stage of the manipulation.

11.Remove gloves, immerse in a container with disinfectant

means.

12.Place an ice pack on your lower abdomen.

13. Conduct dynamic monitoring of the condition of the postpartum woman

(control of blood pressure, pulse, skin color

integument, condition of the uterus, discharge from the genital tract).

14.As prescribed by the doctor, begin antibacterial therapy and administer

uterotonic drugs.

Manual release placenta - an obstetric operation consisting of separating the placenta from the walls of the uterus with a hand inserted into the uterine cavity, followed by removal of the placenta.

INDICATIONS Normal succession period characterized by separation of the placenta from the walls of the uterus and expulsion of the placenta in the first 10–15 minutes after the birth of the child. If there are no signs of separation of the placenta within 30–40 minutes after the birth of the child (in case of partial tight, complete firm attachment or placenta accreta), as well as in case of strangulation of the separated placenta, an operation of manual separation of the placenta and release of the placenta is indicated.

METHODS OF PAIN RELIEF Intravenous or inhalational general anesthesia.

OPERATIONAL TECHNIQUE After appropriate treatment of the surgeon’s hands and the patient’s external genitalia, the right hand, dressed in a long surgical glove, is inserted into the uterine cavity, and the bottom of the uterus is fixed with the left hand from the outside. The umbilical cord serves as a guide to help find the placenta. Having reached the place of attachment of the umbilical cord, the edge of the placenta is determined and, with sawtooth movements, it is separated from the wall of the uterus. Then, by pulling the umbilical cord with the left hand, the placenta is released; the right hand remains in the uterine cavity to conduct a control examination of its walls. The delay of parts is determined by examining the released placenta and detecting a defect in the tissue, membranes, or the absence of an additional lobule. A placental tissue defect is detected by examining the maternal surface of the placenta, spread out on a flat surface. Retention of the accessory lobe is indicated by the identification of a torn vessel along the edge of the placenta or between the membranes. The integrity of the membranes is determined after they have been straightened, for which the placenta should be raised.

After the end of the operation, before removing the arm from the uterine cavity, 1 ml of a 0.2% solution of methylergometrine is injected intravenously at the same time, and then intravenous drip administration of drugs that have a uterotonic effect (5 IU of oxytocin) is started, an ice pack is placed on the suprapubic area of the abdomen.

COMPLICATIONS In the case of placenta accreta, attempting to manually separate it is ineffective. Placental tissue tears and does not separate from the uterine wall, causing profuse bleeding, quickly leading to the development of hemorrhagic shock as a result of uterine atony. In this regard, if placenta accreta is suspected, it is indicated surgical removal uterus on an emergency basis. The final diagnosis is made after histological examination.

12. Method for determining blood group and Rh factor.

To determine your blood group and Rh factor you must:

☞ dry glass slide (standard plate) to determine blood group;

☞ anti-A zoliclones ( pink color) and anti-B ( blue);

☞ two pipettes for taking zoliclones from vials;

☞ 2 glass rods for mixing the patient’s blood with zoliclones;

☞ a syringe (5-10 ml) with a needle for drawing blood from the patient’s vein;

☞ rubber tourniquet for intravenous punctures;

☞ a dry centrifuge tube on which to clearly sign the patient’s name with a glass graph;

☞ form - referral to the laboratory, where the doctor-laboratorian re-determines the blood type, Rh affiliation, puts a stamp and signature

Technique. Following all the rules for intravenous punctures, draw blood from the patient’s vein (at least 5 ml). Anti-A and anti-B zoliclones are applied to a tablet or plate, one large drop (0.1) under the appropriate inscriptions: anti-A and anti-B. Next to the drops of antibodies, the test blood is applied one small drop (0.01 ml).

After mixing the reagents and blood with different glass rods for anti-A and anti-B in a ratio of 1:10, the agglutination reaction is observed for 2.5 minutes. Read the results after 5 minutes while stirring the drops. (from 3 to 5 minutes)

The result is assessed by a doctor. An assessment of the results of the agglutination reaction with anti-A and anti-B Zoliclones is presented in the table, which also includes the results of determining agglutinins in donor serum (plasma) using standard erythrocytes.

In order to exclude autoagglutination, which can be observed in cord blood newborns, if blood group AB(IV) is established, it is necessary to carry out a control test: mix one drop (0.1 ml) of isotonic sodium chloride solution with a small drop (0.01 ml) of the blood being tested. There should be NO agglutination.

Determination of Rh factor using a monoclonal reagent (Coliclone anti-D Super)

A large drop of reagent (about 0.1 ml) is placed on the plate. A small drop (0.01-0.05 ml) of the blood being tested is placed nearby and the blood is mixed with the reagent. The agglutination reaction begins to develop after 10-15 seconds, clearly defined agglutination occurs after 30-60 seconds. (Rh positive, no agglutination - Rh negative). The reaction results are taken into account after 3 minutes. After mixing the reagent with blood, it is recommended to shake the plate not immediately, but after 20-30 seconds, which allows a more complete large-petal agglutination to develop during this time.

Manual separation of the placenta is an obstetric operation consisting of separating the placenta from the walls of the uterus with a hand inserted into the uterine cavity, followed by removal of the placenta.

INDICATIONS

The normal afterbirth period is characterized by separation of the placenta from the walls of the uterus and expulsion of the placenta in the first 10–15 minutes after the birth of the child.

If there are no signs of separation of the placenta within 30–40 minutes after the birth of the child (in case of partial tight, complete firm attachment or placenta accreta), as well as in case of strangulation of the separated placenta, an operation of manual separation of the placenta and release of the placenta is indicated.

METHODS OF PAIN RELIEF

Intravenous or inhalational general anesthesia.

OPERATIONAL TECHNIQUE

After appropriate treatment of the surgeon’s hands and the patient’s external genitalia, the right hand, dressed in a long surgical glove, is inserted into the uterine cavity, and the bottom of the uterus is fixed with the left hand from the outside. The umbilical cord serves as a guide to help find the placenta. Having reached the place of attachment of the umbilical cord, the edge of the placenta is determined and, with sawtooth movements, it is separated from the wall of the uterus. Then, by pulling the umbilical cord with the left hand, the placenta is released; the right hand remains in the uterine cavity to conduct a control examination of its walls. The delay of parts is determined by examining the released placenta and detecting a defect in the tissue, membranes, or the absence of an additional lobule. A placental tissue defect is detected by examining the maternal surface of the placenta, spread out on a flat surface. Retention of the accessory lobe is indicated by the identification of a torn vessel along the edge of the placenta or between the membranes. The integrity of the membranes is determined after they have been straightened, for which the placenta should be raised.

COMPLICATIONS

In the case of placenta accreta, attempting to manually separate it is ineffective. The placental tissue ruptures and does not separate from the wall of the uterus, profuse bleeding occurs, quickly leading to the development of hemorrhagic shock as a result of uterine atony. In this regard, if placenta accreta is suspected, surgical removal of the uterus is indicated on an emergency basis. The final diagnosis is established after histological examination.

Examination of the birth canal in the postpartum period

Examination of the birth canal

After childbirth, the birth canal must be examined for ruptures. To do this, special spoon-shaped speculums are inserted into the vagina. First, the doctor examines the cervix. To do this, the cervix is taken with special clamps, and the doctor walks around its perimeter, interlocking the clamps. At the same time, a woman can feel pulling sensations lower abdomen. If there are cervical ruptures, they are sutured; no anesthesia is required, since there are no pain receptors in the cervix. Then the vagina and perineum are examined. If there are tears, they are sutured.

Stitching of tears is usually carried out under local anesthesia(Novocaine is injected into the area of the rupture or the genitals are sprayed with lidocaine spray). If manual separation of the placenta or examination of the uterine cavity was carried out under intravenous anesthesia, then the examination and suturing are also carried out under intravenous anesthesia (the woman is removed from anesthesia only after completion of the examination of the birth canal). If there was an epidural anesthesia, then an additional dose of anesthesia is administered through a special catheter left in the epidural space from the time of birth. After the examination, the birth canal is treated with a disinfectant solution.

The amount of bloody discharge must be assessed. At the exit from the vagina, a tray is placed where everyone gathers spotting, the blood remaining on napkins and diapers is also taken into account. Normal blood loss is 250 ml, up to 400-500 ml is acceptable. Large blood loss may indicate hypotension (relaxation) of the uterus, retained parts of the placenta, or an unsutured rupture.

Two hours after birth

Early postpartum period includes the first 2 hours after birth. During this period there may be various complications: bleeding from the uterus, formation of a hematoma (accumulation of blood in a confined space). Hematomas can cause compression of surrounding tissues, a feeling of fullness, in addition, they are a sign of an unsutured rupture, bleeding from which may continue, and after some time the hematomas may fester. Periodically (every 15-20 minutes), a doctor or midwife approaches the young mother and evaluates the contraction of the uterus (for this, the uterus is palpated through the anterior abdominal wall), the nature of the discharge and the condition of the perineum. After two hours, if everything is normal, the woman and baby are transferred to the postpartum ward.

Exit obstetric forceps. Indications, conditions, technique, prevention of complications.

The application of obstetric forceps is a delivery operation during which the fetus is removed from the mother's birth canal using special instruments.

Obstetric forceps are intended only for removing the fetus by the head, but not for changing the position of the fetal head. The purpose of the operation of applying obstetric forceps is to replace the labor expulsion forces with the attractive force of the obstetrician.

Obstetric forceps have two branches connected to each other using a lock; each branch consists of a spoon, a lock and a handle. The spoons of the forceps have a pelvic and cephalic curvature and are designed specifically for grasping the head; the handle is used for traction. Depending on the design of the lock, there are several modifications of obstetric forceps; in Russia, Simpson-Fenomenov obstetric forceps are used, the lock of which is characterized by a simple design and significant mobility.

CLASSIFICATION

Depending on the position of the fetal head in the small pelvis, the surgical technique varies. When the fetal head is positioned in wide plane Cavity or atypical forceps are applied to the pelvis. Forceps applied to the head, located in the narrow part of the pelvic cavity (the arrow-shaped suture is almost in straight size), are called low cavity (typical).

Most favorable option operations associated with the smallest number complications for both the mother and the fetus - the application of typical obstetric forceps. Due to the expansion of indications for CS surgery in modern obstetrics, forceps are used only as a method of emergency delivery if the opportunity to perform CS is missed.

INDICATIONS

· Preeclampsia severe course, not amenable conservative therapy and requiring exclusion of efforts.

Persistent secondary weakness labor activity or weakness of pushing, not giving in medicinal correction, accompanied by prolonged standing of the head in one plane.

· PONRP in the second stage of labor.

· The presence of extragenital diseases in the woman in labor that require stopping pushing (diseases of the cardiovascular system, high myopia, etc.).

· Acute fetal hypoxia.

CONTRAINDICATIONS

Relative contraindications- prematurity and large fetus.

CONDITIONS FOR THE OPERATION

· Live fruit.

· Complete opening of the uterine os.

· Absence of amniotic sac.

· The location of the fetal head in the narrow part of the pelvic cavity.

· Correspondence between the sizes of the fetal head and the mother's pelvis.

PREPARATION FOR OPERATION

It is necessary to consult an anesthesiologist and choose a method of pain relief. The woman in labor is in a supine position with her knees bent and hip joints feet. Emptying bladder, process disinfectant solutions external genitalia and inner surface thighs of the woman in labor. A vaginal examination is performed to clarify the position of the fetal head in the pelvis. The forceps are checked, and the obstetrician's hands are treated as for performing a surgical operation.

METHODS OF PAIN RELIEF

The method of pain relief is chosen depending on the condition of the woman and fetus and the nature of the indications for surgery. U healthy woman(if it is appropriate for its participation in the birth process) with weakness of labor or acute fetal hypoxia, you can use epidural anesthesia or inhalation of a mixture of nitrous oxide and oxygen. If it is necessary to turn off pushing, the operation is performed under anesthesia.

OPERATIONAL TECHNIQUE

General technology the operation of applying obstetric forceps includes the rules for applying obstetric forceps, which are observed regardless of the plane of the pelvis in which the fetal head is located. The operation of applying obstetric forceps necessarily includes five stages: inserting spoons and placing them on the fetal head, closing the branches of the forceps, test traction, removing the head, removing the forceps.

Rules for introducing spoons

· The left spoon is held with the left hand and inserted into left side mother's pelvis under the control of the right hand, the left spoon is inserted first, as it has a lock.

The right spoon is held with the right hand and inserted into right side mother's pelvis on top of the left spoon.

To control the position of the spoon, all fingers of the obstetrician’s hand are inserted into the vagina, except for the thumb, which remains outside and is moved to the side. Then, like a writing pen or bow, take the handle of the forceps, with the top of the spoon facing forward and the handle of the forceps parallel to the opposite inguinal fold. The spoon is inserted slowly and carefully using pushing movements thumb. As the spoon moves, the handle of the tongs is moved to a horizontal position and lowered down. After inserting the left spoon, the obstetrician removes his hand from the vagina and passes the handle of the inserted spoon to the assistant, who prevents the spoon from moving. Then the second spoon is introduced. The spoons of the forceps rest on the fetal head in its transverse dimension. After inserting the spoons, the handles of the tongs are brought together and an attempt is made to close the lock. This may cause difficulties:

· the lock does not close because the spoons of the forceps are not placed on the head in the same plane - the position of the right spoon is corrected by displacing the branch of the forceps with sliding movements along the head;

· one spoon is located higher than the other and the lock does not close - under the control of fingers inserted into the vagina, the overlying spoon is shifted downwards;

· the branches are closed, but the handles of the forceps diverge greatly, which indicates that the spoons of the forceps are placed not on the transverse size of the head, but on the oblique one, about large sizes head or too high position of the spoons on the fetal head, when the tops of the spoons rest against the head and the head curvature of the forceps does not fit it - it is advisable to remove the spoons, conduct a second vaginal examination and try again to apply the forceps;

· the internal surfaces of the handles of the forceps do not fit tightly to each other, which usually occurs if the transverse size of the fetal head is more than 8 cm - a diaper folded in four is placed between the handles of the forceps, which prevents excessive pressure on the fetal head.

After closing the branches of the tongs, check whether they are caught by the tongs soft fabrics birth canal. Then a test traction is carried out: the handles of the forceps are grabbed with the right hand, fixed with the left hand, index finger of the left hand are in contact with the head of the fetus (if during traction it does not move away from the head, then the forceps are applied correctly).

Next, the actual traction is carried out, the purpose of which is to extract the fetal head. The direction of traction is determined by the position of the fetal head in the pelvic cavity. When the head is in the wide part of the pelvic cavity, the traction is directed downward and backward; when traction is from the narrow part of the pelvic cavity, the attraction is directed downward, and when the head is located at the outlet of the small pelvis, it is directed downward, toward oneself and anteriorly.

Tractions should imitate contractions in intensity: gradually begin, intensify and weaken, a pause of 1–2 minutes is necessary between tractions. Usually 3–5 tractions are enough to extract the fetus.

The fetal head can be brought out in forceps or they are removed after bringing the head down to the exit of the small pelvis and vulvar ring. When passing the vulvar ring, the perineum is usually cut (obliquely or longitudinally).

When removing the head, you may encounter such serious complications, such as the lack of advancement of the head and the slipping of spoons from the fetal head, the prevention of which consists in clarifying the position of the head in the pelvis and correcting the position of the spoons.

If the forceps are removed before the head erupts, then first the handles of the forceps are spread apart and the lock is unlocked, then the spoons of the forceps are withdrawn in the reverse order of insertion - first the right, then the left, deflecting the handles towards the opposite thigh of the woman in labor. When removing the fetal head in forceps, traction is carried out with the right hand in the anterior direction, and the perineum is supported with the left. After the head is born, the lock of the forceps is opened and the forceps are removed.

Obstetric forceps.

Parts: 2 curvatures: pelvic and head, apexes, spoons, lock, Bush hooks, ribbed handles.

With the correct position in the hands - look up, above and in front - pelvic bend.

Indications:

1. from mother's side:

EGP in the stage of decompensation

· Severe PTB (BP = 200 mm Hg - you can’t push)

High myopia

2. from labor: weakness of pushing

3. from the fetus: progression of fetal hypoxia.

Conditions for use:

· the pelvis should not be narrow

· The BL must be fully opened (10 – 12 cm) – otherwise the BL may be damaged by separation

· amniotic sac must be opened, otherwise PONRP

· the head should not be large - it will not be possible to close the forceps. If it's small, it will slip off. For hydrocephalus, prematurity - forceps are contraindicated

the head should be at the outlet of the pelvis

Preparation:

remove urine with a catheter

· treatment of the doctor’s hands and female genital organs

episiotomy – to protect the perineum

· assistant

· anesthetize: intravenous anesthesia or pudendal anesthesia

Technique:

3 triple rules:

1. the direction of traction (this is a driving movement) cannot be rotated in 3 positions:

· on the obstetrician's socks

· on yourself

· on the obstetrician's face

2. 3 from left: left spoon in left hand V left half pelvis

3. 3rd right: right spoon with right hand in right half pelvis

· placing spoons on the head:

· the tops are facing the conductive head

· spoons cover the head with the largest circumference (from the chin to the small fontanelle)

· the conducting point lies in the plane of the forceps

Stages:

Insertion of spoons: the left spoon is placed in the left hand like a bow or pen, the right spoon is given to the assistant. The right hand (4 fingers) is inserted into the vagina, a spoon is inserted along the arm, pointing forward with the thumb. When the jaw is parallel to the table, stop. Do the same with the right spoon.

Closing the forceps: if the head is large, then the diaper is clamped between the handles.

Test traction - will the head move behind the forceps? Place the 3rd finger of the right hand on the lock, 2 and 4 fingers on the Bush hooks, and 5 and 1 on the handle. Test traction +3 finger of the left hand on the sagittal suture.

Traction itself: on top of the right hand - the left hand.

Removing the forceps: remove your left hand and spread the jaws of the forceps with it

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 takes place with the release of special substances - enzymes, which make a small area of the uterine mucosa loose enough so that the zygote can take hold 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 everything important and necessary for its development. full development substances. 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 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.” And he is important characteristic 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 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 placenta and placenta as a single organ. 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. Its specialists functional role defined as the blood-placental barrier. The multilayer structure of this “cake” connecting the growing, developing fetus and the maternal body, allows you to successfully protect the baby from pathological hazardous 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 the products of its vital activity. From the moment of conception and a little longer after childbirth - that's " life path"placenta. From the very beginning it protects future life, passing 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, the placenta retains.

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 to proper development 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 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 blood pressure expectant mother on normal level during 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.

Hormones and enzymes produced by the placenta change throughout pregnancy, helping a woman's body cope serious workload, and the fetus grows and develops. Natural birth or C-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 last.

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, as 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 examination, can see for themselves that the placenta migrates from a lower location to an upper one.

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, it is given special attention during examinations. close attention. Ultrasound examination pregnancy allows the doctor to assess the location of the placenta, the features of its development throughout the entire period of gestation.

The condition of the placenta is also assessed during laboratory tests on the amount of placental hormones and the activity of its enzymes, and Doppler measurements help determine the blood flow of each vessel of the fetus, uterus and umbilical cord.

The condition of the placenta plays a role important role and in the most crucial period - the period of childbirth, because it remains the only opportunity for the baby passing through birth canal, receive all the substances and oxygen it 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 the umbilical cord diverges blood vessels. WITH reverse side the afterbirth has a lobed structure and a dark brown tint of the shell.

When the birth is complete, pathological processes has not 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 staff attempts 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 surgical method. Such manipulations are carried out under general anesthesia. Moreover, complete fusion of the placenta and uterus can be resolved the only way- removal of the uterus.

The placenta after childbirth is examined by a doctor, and if damage or defects are found, especially with continued uterine bleeding women in labor, then a so-called cleaning is carried out to remove the remaining parts of the placenta.

Massage for the placenta

IN natural childbirth not such a rare problem - the placenta did not come out. What to do in this case? One of the effective and safe ways- 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 bottom, anterior and back wall 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 complex system maintaining the 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 - separate body, potentially susceptible 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 even 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 fresh 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 a 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.

Indications:

Bleeding in the 3rd stage of labor caused by abnormalities in the separation of the placenta.
No signs of placental separation or bleeding within 30 minutes after birth.
If external methods of releasing the placenta are not effective.
At premature detachment normally located placenta.

Equipment: clamp, 2 sterile diapers, forceps, sterile balls, skin antiseptic.

Preparation for manipulation:

Wash your hands surgically, wear sterile gloves.
Toilet the external genitalia.
Place sterile diapers under the woman's pelvis and on her stomach.
Treat the external genitalia with a skin antiseptic.
The operation is performed under IV anesthesia.

Performing the manipulation:

The labia are spread apart with the left hand, and the right hand is folded into a cone, back side facing the sacrum, inserted into the vagina, and then into the uterus, guided by the umbilical cord.
The edge of the placenta is found and, using “sawing” movements of the hand, the placenta is gradually separated from the wall of the uterus. At this time, the outer hand helps the inner hand, pressing on the fundus of the uterus.
After separation of the placenta, it is brought to the lower segment of the uterus and removed with the left hand by pulling the umbilical cord.
With the right hand, carefully examine the inner surface of the uterus again to exclude the possibility of retention of parts of the placenta.
Then the hand is removed from the uterine cavity.

Completing the manipulation:

Inform the patient that the procedure is complete.
Disinfection of reusable equipment: mirror, lifting forceps according to OST in 3 stages (disinfection, pre-sterialization cleaning, sterilization). Disinfection of used gloves: (O cycle - rinse, I cycle - immerse at 60 /) with subsequent disposal class “B” - yellow bags.
Disinfection of used dressing material with subsequent disposal in accordance with SanPiN 2.1.7. – 2790-10..
Treat the gynecological chair with a rag soaked in disinfectant. solution twice with an interval of 15 minutes.
Wash your hands as usual and dry. Treat with moisturizer.
Help the patient rise from the chair.