Obstetrics and Gynecology - A. M. Gromova 2000

Obstetric Hemorrhage
Hemorrhage in the Placental and Early Postpartum Periods
Anomalies of Placental Separation and Delivery of the Placenta

Sometimes the Placenta fails to detach completely from the uterine wall, leaving certain lobes retained within the uterine cavity. This condition is known as a placental defect.

This pathology is diagnosed by examining the maternal surface of the placenta for the absence of one or more cotyledons and observing tissue bleeding at the site of the defect. An additional lobe located on the fetal membranes may also remain in the uterine cavity. The presence of such a lobe can be identified by tracing the course of the Blood Vessels on the fetal surface of the placenta. These vessels extend beyond the placental margin and abruptly terminate on the membranes.

When a placental lobe is retained in the uterine cavity, it impairs uterine contractility, predisposing the patient to hypotonic Hemorrhage and infection (Postpartum Endometritis).

If a placental defect is detected, if an accessory lobe or 2/3 of the membranes remain in the Uterus, or even if retention of a placental part is merely suspected, surgical intervention is required—namely, Manual Exploration of the uterine cavity and removal of the retained placental tissue.

Occasionally, a placenta that has already separated from the uterine walls cannot be expelled during maternal pushing due to incarceration of the secundines within the uterine cavity. This may occur following the administration of high doses of uterotonic agents, aggressive uterine massage, or in cases of uterine anomalies. In cases of placental incarceration, bleeding may or may not be present, while signs of placental Separation remain positive. Under such circumstances, the administration of antispasmodics is indicated, along with expression of the placenta using the Credé-Lazareвич maneuver. Should conservative measures prove ineffective, manual removal of the placenta via exploration of the uterine cavity under deep general anesthesia is indicated.



Last update: 08/08/2026

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