The standard treatment for retained placenta is manual extraction, in which a hand
is introduced inside the uterus to cleave a plane between the placenta and the uterine
wall. For women without an epidural, the procedure is extremely uncomfortable and
may require additional measures such as intravenous narcotics or regional anesthesia.
Although ultrasound-guided instrumental removal of the placenta is standard practice
as part of second-trimester abortion by dilation and evacuation and may be done at
many institutions, especially after failed manual extraction, it has not yet been
described in the literature as a technique following vaginal birth. Our experience
with this technique is that it causes less discomfort to the patient than a traditional
manual extraction, because the instrument entering the uterus is much narrower than
a hand. With the patient in dorsal lithotomy, we locate the cervix and stabilize it
either with fingers or a ring forceps on the anterior lip. We introduce Bierer ovum
forceps into the uterus under direct ultrasound guidance. The Bierer forceps are preferred
because of their long length, large head, and serrated teeth that allow for a firm,
secure grip on the placenta. We grasp the placental tissue with the forceps and apply
slow, gentle traction in short strokes, regrasping increasingly more distal areas
of placenta as necessary to tease out the placenta. After 1-2 minutes, the placenta
separates and can be pulled out of the uterus, usually intact. Our experience suggests
that this technique is a well-tolerated option for women without an epidural who have
a retained placenta. Further study is needed to quantify the amount of discomfort
and anesthesia that can be avoided with this technique, as well as whether there is
any change in the frequency of infectious complications or the necessity of postremoval
curettage.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Obstetrics & GynecologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prolonged third stage of labor: morbidity and risk factors.Obstet Gynecol. 1991; 77: 863-867
- Third stage of labor: analysis of duration and clinical practice.Am J Obstet Gynecol. 1995; 172: 1279-1284
- The retained placenta: historical and geographical rate variations.J Obstet Gynaecol. 2011; 31: 37-42
- Second-trimester surgical abortion.Clin Obstet Gynecol. 2009; 52: 179-187
Article info
Publication history
Published online: April 14, 2014
Accepted:
April 9,
2014
Received in revised form:
April 2,
2014
Received:
February 3,
2014
Footnotes
The authors report no conflict of interest.
Reprints not available from the authors.
Cite this article as: Rosenstein MG, Vargas JE, Drey EA. Ultrasound-guided instrumental removal of the retained placenta after vaginal delivery. Am J Obstet Gynecol 2014;211:180.e1-3.
Identification
Copyright
© 2014 Mosby, Inc. Published by Elsevier Inc. All rights reserved.