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Manual Removal of the Placenta after Vaginal Delivery: An Unsolved Problem in Obstetrics

The third stage of labor is associated with considerable maternal morbidity and mortality. The major complication is postpartum hemorrhage (PPH), which is the leading cause of maternal morbidity and mortality worldwide. Whereas in the event of PPH due to atony of the uterus there exist numerous trea...

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Detalles Bibliográficos
Autores principales: Urner, Fiona, Zimmermann, Roland, Krafft, Alexander
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi Publishing Corporation 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4000637/
https://www.ncbi.nlm.nih.gov/pubmed/24812585
http://dx.doi.org/10.1155/2014/274651
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author Urner, Fiona
Zimmermann, Roland
Krafft, Alexander
author_facet Urner, Fiona
Zimmermann, Roland
Krafft, Alexander
author_sort Urner, Fiona
collection PubMed
description The third stage of labor is associated with considerable maternal morbidity and mortality. The major complication is postpartum hemorrhage (PPH), which is the leading cause of maternal morbidity and mortality worldwide. Whereas in the event of PPH due to atony of the uterus there exist numerous treatment guidelines; for the management of retained placenta the general consensus is more difficult to establish. Active management of the third stage of labour is generally accepted as standard of care as already its duration is contributing to the risk of PPH. Despite scant evidence it is commonly advised that if the placenta has not been expelled 30 minutes after delivery, manual removal of the placenta should be carried out under anaesthesia. Pathologic adhesion of the placenta in the low risk situation usually is diagnosed at the time of delivery; therefore a pre- or intrapartum screening opportunity for placenta accreta would be desirable. But diagnosis of abnormalities of placentation other than placenta previa remains a challenge. Nevertheless the use of ultrasound and doppler sonography might be helpful in the third stage of labor. An improvement might be the implementation of standardized operating procedures for retained placenta which could contribute to a reduction of maternal morbidity.
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spelling pubmed-40006372014-05-08 Manual Removal of the Placenta after Vaginal Delivery: An Unsolved Problem in Obstetrics Urner, Fiona Zimmermann, Roland Krafft, Alexander J Pregnancy Review Article The third stage of labor is associated with considerable maternal morbidity and mortality. The major complication is postpartum hemorrhage (PPH), which is the leading cause of maternal morbidity and mortality worldwide. Whereas in the event of PPH due to atony of the uterus there exist numerous treatment guidelines; for the management of retained placenta the general consensus is more difficult to establish. Active management of the third stage of labour is generally accepted as standard of care as already its duration is contributing to the risk of PPH. Despite scant evidence it is commonly advised that if the placenta has not been expelled 30 minutes after delivery, manual removal of the placenta should be carried out under anaesthesia. Pathologic adhesion of the placenta in the low risk situation usually is diagnosed at the time of delivery; therefore a pre- or intrapartum screening opportunity for placenta accreta would be desirable. But diagnosis of abnormalities of placentation other than placenta previa remains a challenge. Nevertheless the use of ultrasound and doppler sonography might be helpful in the third stage of labor. An improvement might be the implementation of standardized operating procedures for retained placenta which could contribute to a reduction of maternal morbidity. Hindawi Publishing Corporation 2014 2014-04-09 /pmc/articles/PMC4000637/ /pubmed/24812585 http://dx.doi.org/10.1155/2014/274651 Text en Copyright © 2014 Fiona Urner et al. https://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review Article
Urner, Fiona
Zimmermann, Roland
Krafft, Alexander
Manual Removal of the Placenta after Vaginal Delivery: An Unsolved Problem in Obstetrics
title Manual Removal of the Placenta after Vaginal Delivery: An Unsolved Problem in Obstetrics
title_full Manual Removal of the Placenta after Vaginal Delivery: An Unsolved Problem in Obstetrics
title_fullStr Manual Removal of the Placenta after Vaginal Delivery: An Unsolved Problem in Obstetrics
title_full_unstemmed Manual Removal of the Placenta after Vaginal Delivery: An Unsolved Problem in Obstetrics
title_short Manual Removal of the Placenta after Vaginal Delivery: An Unsolved Problem in Obstetrics
title_sort manual removal of the placenta after vaginal delivery: an unsolved problem in obstetrics
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4000637/
https://www.ncbi.nlm.nih.gov/pubmed/24812585
http://dx.doi.org/10.1155/2014/274651
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