After the baby is safely born its time to deliver the placenta. Usually it delivers within half an hour. As the placenta comes out, hold it in both hands and twist it to bring all the membranes together. There should be minimal bleeding that stops quickly. Sometimes though, a piece of placenta is left behind in the uterus. This can lead to continuous bleeding and infection. This video shows how to examine the placenta for any missing pieces.
Let’s first see what happens to the placenta from inside the body: after the baby is born, the uterus contracts and soon after the placenta separates from the wall of the uterus. A clot of blood forms where it has separated. The uterus continues to contract, closing off the bleeding vessels, as the placenta moves down and through the birth canal to deliver. Sometimes though, pieces are left behind in the uterus. Even a small piece can prevent the uterus from contracting and the vessels will continue to bleed. This can lead to hemorrhage or infection.
It’s important to carefully examine the placenta. The smooth and shiny side faced the baby in the uterus. The cord attaches on this side, and then spreads out into many deep-blue blood vessels. The maternal side of the placenta is the rough, red, meaty side that is attached to the wall of the uterus during pregnancy.
To check the placenta for completeness:
Hold the placenta in the palms of your gloved hands, with the maternal side facing upward. Look carefully to be sure that all the lobes are present and fit together. Check the edges of the placenta for torn veins that could indicate extra lobes. There should be no missing piece or sign of breakage when the placenta is stretched flat over your hands. It’s not really necessary to inspect the membranes for missing parts. Usually the body will expel any membrane fragments. If a portion of the maternal surface of the placenta is missing, it’s likely that placenta pieces are still in the uterus.
It can be dangerous for the mother if any parts of the placenta are left behind. She is at risk of postpartum hemorrhage and infection, because the uterus will not be able to contract completely. If you see anything protruding from the vagina or she continues to bleed, explain to the mother that you need to check inside her vagina. Wear sterile gloves and gently examine the upper vagina and cervix of the woman. Use a sponge forceps to remove any pieces of placenta or membrane that are present in the vagina. If you suspect the missing piece of placenta is still in the uterus, transfer the mother to have these pieces removed in a sterile manner by a trained health worker.
Remember, examine the maternal side of the placenta for completeness. Sometimes a piece can be left behind. Placenta pieces left inside the uterus can cause hemorrhage or infection.
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