Surgery in the placental stage of labor and early postpartum period is performed to treat uterine hemorrhage and vaginal bleeding and to restore the integrity of damaged organs and tissues.
Types of surgeries in the placental stage of labor and early postpartum period:
1) manual separation of placenta and removal of afterbirth (or placental lobule);
2) manual examination of uterus;
3) curettage of postpartum uterus;
4) examination and suturing of cervical lacerations;
5) suturing of vulvar, perineal and vaginal lacerations.
5.1. MANUAL SEPARATION OF PLACENTA AND REMOVAL OF AFTERBIRTH (OR PLACENTAL LOBULE)
Placental stage is the shortest and most dangerous of all three periods of labor. It is always accompanied by blood loss, since in hemochoric type of human placenta uteroplacental vessels are ruptured during placenta separation. However, terminal branches of the spiral arteries are quickly twisted and compressed by contracted muscle fibers of myometrium (processes of contact and retraction) in normal uterine contractile activity.
Thromboplastic substances released during placenta separation enter the vasculature of the placental site leading to thrombosis. This reduces blood loss in delivery to 100-250 ml and prevents severe (pathological) blood loss.
If the patient has tight adherence (increment) of the placenta, obstetric complications, and impairment of the hemostatic system, situations can occur when the placenta does not separate spontaneously, or is expelled but has a defect of its tissue, for example, if a placental lobule remained in the uterus.
In this case, it is necessary to perform manual separation and extraction of placenta. Interestingly, the uterus has a feature: if a lobule, or even a small fragment of the placenta, is retained in its cavity, the uterus does not contract. Bleeding does not stop, and if it stopped after the administration of uterotonic drugs, it will certainly recur.