Delivery of placenta can be done by different methods. This methods can be natural or it can be induced. However in this article we have taking our time to explain the different methods of placenta delivery.
Maternal Effort
This is the natural and best method of delivering placenta.
The procedures include;
- Instruct the patient to hold her breath and bear down when the uterus contracts.
- You may help her by placing your palms flat on the patient abdomen as a brace against which she could push.
- Catch the placenta as it is expelled, in both hands and turn it round making a complete circle.
- This action will twist the membranes into a rope and strengthen them, thus reducing the risk of tearing and some fragments being retained.
Fundal Pressure
In the method of delivery of placenta, pressure is applied on the fundus with the palm of the hand in a downward and backward direction in the axis of the pelvic inlet.
The procedures include;
- Encourage the patient to breathe through her mouth during the procedure in order to aid relation of the abdominal muscles.
- The fundus should be well contracted to act as a position o push the placenta out in the same way as the piston is used to push the fluid out of the barrel of syringe.
Read Also: Episiotomy-Procedures and Indications
Brandt Andrew’s Manoeuvre
This involves the lifting of an already separated and descended placenta from the vagina or the lower uterine segment by pulling on its cord.
The procedures include;
- Wind the cord round the finger twice
- Gently pull the placenta downward to deliver it
- If the uterus is well contracted there will be no risk associated with this manoevre.
Controlled Cord Traction
This method of delivery of placenta is known as the modified Brandt Andrew’s Manoeuvre. In this method, the separation and control of the placenta is hastened by the administration of some prescribed injection after delivery of baby.
The procedures include;
- Identify the signs that the placenta has left the upper uterine segment. This signs include strong uterine contraction, trickling of fresh blood from the vulva and elongation of the cord.
- With an artery forceps clamp on the cord at a point nearer to the vulva.
- Wound the cord round the forceps with the right hand.
- Place the left above the symphysis pubis pushing the upper uterine segment upwards, thus bracing the uterus while firm gentle traction is on the cord to expel the placenta.
- Once the placenta is visible on the vulva, stop the traction and cup the placenta in both hands.
- Separate the membranes by moving the placenta in the cupped hands up and down gently to prevent the membrane from tearing off and being retained in the uterus.
In this method, there is increased risk of uterine inversion or breaking of the cord in the hands of an inexperienced midwife. To reduce the danger of inversion, ensure that the uterus is well contracted and apply counter pressure on the supra-pubic region abdominally before applying cord traction.
Manual Removal of Placenta
This method is not used in normal midwifery, it is done under the influence of anaesthesia by a doctor or an experienced midwife when other methods have failed, that is in case of retained placenta. Retained placenta is diagnosed when the placenta remains undelivered after 30 minutes to one hour after delivery of baby.
The procedures include;
- It is a sterile procedure so scrub, mask and don gloves.
- Position patient in lithotomy position.
- Give patient anaesthesia.
- Swab the vulva and vagina.
- Catheterize patient to empty the bladder and also avoid injury to the bladder.
- Re-drape patient.
- Hold the umbilical cord with your left hand
- Pass your right hand with fingers to thumb(form a fist) to form a shape like cone through the vagina into the uterine cavity following the direction of the cord.
- Once the placenta is located, the cord is released from the left hand.
- Steady the fundus of the uterus abdominally with your left hand to prevent rupture of the lower uterine segment.
- The fingers inside the uterus now follow the umbilical cord to the placenta.
- Seek the corners edge of the placenta or separated edge and then gradually separate (peel off) from the uterine wall.
- The external hand steadies the fundus and serves as a guide and also reduces the risk of tearing the uterus.
- The separation is continued until the whole of the placenta has been completely detached. Detach the placenta completely before removal to prevent fragments being torn off and retained.
- The placenta mass is grasped in the hand and withdrawn gently into the vagina, membranes being peeled off behind it.
- When the placenta is completely detached, extraction is done by the traction on the cord with the outside hand.
- The inside hand remains inside to examine the walls of the uterus completely for evidence of significant damage, and to ensure that no placenta tissue remain attached. By this method re introduction of the hand is avoided and risk for infection reduced.
- Ensure that no piece of placenta if left behind by exploring the uterus carefully.
- Upon completion of the procedure, an oxytocic drug is given
Crede’s Method
This method is not used in normal midwifery. In fact it is never used. This involves placing one hand on the top of the uterus(uterine fundus) and squeezing it between the thumb and other fingers to help placenta separation and delivery.
We hope this information was helpful. Feel free to ask your questions in the comment section below.