1. Retained placenta: will medical treatment ever be possible?
- Author
-
Akol AD and Weeks AD
- Subjects
- Clinical Decision-Making, Disease Management, Female, Humans, Pregnancy, Risk Adjustment, Musculoskeletal Manipulations adverse effects, Musculoskeletal Manipulations methods, Myometrium drug effects, Myometrium physiopathology, Oxytocics administration & dosage, Oxytocics adverse effects, Placenta, Retained diagnosis, Placenta, Retained etiology, Placenta, Retained physiopathology, Placenta, Retained therapy, Tocolytic Agents administration & dosage, Tocolytic Agents adverse effects
- Abstract
The standard treatment for retained placenta is manual removal whatever its subtype (adherens, trapped or partial accreta). Although medical treatment should reduce the risk of anesthetic and surgical complications, they have not been found to be effective. This may be due to the contrasting uterotonic needs of the different underlying pathologies. In placenta adherens, oxytocics have been used to contract the retro-placental myometrium. However, if injected locally through the umbilical vein, they bypass the myometrium and perfuse directly into the venous system. Intravenous injection is an alternative but exacerbates a trapped placenta. Conversely, for trapped placentas, a relaxant could help by resolving cervical constriction, but would worsen the situation for placenta adherens. This confusion over medical treatment will continue unless we can find a way to diagnose the underlying pathology. This will allow us to stop treating the retained placenta as a single entity and to deliver targeted treatments., (© 2016 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)
- Published
- 2016
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