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Results for “Placenta, Retained”

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PubMed1994

Antioxidant status of dairy cows supplemented prepartum with vitamin E and selenium.

Possible relationships among dietary antioxidants, oxidative status, and placental retention were investigated in periparturient dairy cows. During 6 wk prepartum, 16 cows each were given daily by capsule 1000 IU of vitamin E, 3 mg of Se, both vitamin E and Se, or neither (control). alpha-Tocopherol in serum and fast-acting antioxidants in plasma increased, but, in red blood cells, thiobarbituric acid-reactive substances decreased during the last 6 wk before parturition in cows given vitamin E. These measurements were unaffected by supplementation of Se. Cows that had retained placenta > or = 12 h had lower fast-acting antioxidants in plasma and glutathione peroxidase in red blood cells up to 2 wk before calving than did cows that shed fetal membranes in < 12 h. Results suggest that inadequate dietary antioxidants may increase oxidative stress, production of lipid peroxides, and incidence of retained fetal membranes in dairy cows.

Animal Feed↗

PubMed2001

Secondary postpartum haemorrhage: incidence, morbidity and current management.

OBJECTIVE: To determine the incidence, risk factors, presentation, treatment and morbidity associated with secondary postpartum haemorrhage. DESIGN: Analysis of 132 consecutive women presenting with secondary postpartum haemorrhage occurring over a three-year period. SETTING: The maternity unit in a district general teaching hospital serving an annual delivery rate of around 6500 women. MAIN OUTCOME MEASURES: Factors associated with the cause of the haemorrhage and the resulting morbidity. RESULTS: Most women presented during the second week after delivery. A history of primary postpartum haemorrhage (OR 9.3; 95% CI 6.2-14.0) and manual removal of placenta (OR 3.5; 95% CI 1.6-7.5) were the only significant risk factors identified. There was a high associated morbidity, with 84% requiring hospital admission, 63% surgical evacuation, 17% blood transfusion, with three women suffering a uterine perforation, one managed by hysterectomy. In women undergoing evacuation only, 37% had retained placental tissue confirmed after surgery; pre-operative ultrasound examination did not provide a better discrimination over clinical assessment for this finding. CONCLUSIONS: Secondary postpartum haemorrhage occurs in just under 1% of women, is associated with primary postpartum haemorrhage and retained placenta, and may result in significant maternal morbidity. This problem deserves more attention than it has received in recent years.

Blood Transfusion↗

PubMed1992

Postpartum ultrasonographic findings associated with placenta accreta.

Postpartum ultrasonographic examination of a patient with a retained placenta showed findings consistent with placenta accreta. The diagnosis was confirmed after surgery with histopathologic examination of the uterus. This case illustrates the possible clinical application of ultrasonography in the postpartum diagnosis of placenta accreta.

Adult↗

PubMed1999

The relationship between plasma oestrone sulphate concentrations in pregnant dairy cattle and calf birth weight, calf viability, placental weight and placental expulsion.

A total of 54 Holstein-Friesian cows (13 primiparous and 41 multiparous) was used to study maternal plasma oestrone sulphate (E1S) during pregnancy and its relationship to birth weight and viability of calves and time required for placental expulsion after calving. Plasma samples were obtained from the tail vein of cows once every month from days 90 to 180, every 2 weeks from days 181 to 270, and every day from day 270 of gestation to parturition. The E1S concentrations were measured by radioimmunoassay, and birth weight, placental measurements, neonatal viability and the period from calving to placental expulsion were recorded. E1S concentrations were correlated positively (0.71 > or = r > or = 0.32, P < 0.05 or P < 0.01) with calf birth weight and weights of cotyledons, intercotyledonary membranes and total placenta from days 210 of gestation to 1 day prepartum. Calf birth weight was correlated positively (p < 0.01) with the weight of the cotyledons (r = 0.87), intercotyledonary membranes (r = 0.78) and total placenta (r = 0.88). In addition, E1S concentrations were positively correlated (0.63 > or = r > or = 0.28, P < 0.05 or P < 0.01) with the neonatal viability after day 195 of pregnancy, and were negatively correlated (-0.29 > or = r > or = -0.55, P < 0.05 or P < 0.01) with the intervals from parturition to placental expulsion after 225 days of pregnancy. The results suggest that variation among dams for circulating E1S levels during late pregnancy may be caused by variation of placental development and ability for oestrogen production and conjugation, and they may influence fetal growth, neonatal viability and retained placenta.

Animals↗

PubMed2005

Placental cord drainage after spontaneous vaginal delivery as part of the management of the third stage of labour.

BACKGROUND: Cord drainage in the third stage of labour involves unclamping the previously clamped and separated umbilical cord and allowing the blood from the placenta to drain freely into an appropriate receptacle. Currently there are no systematic reviews of the effects of placental cord drainage on the management of the third stage of labour. OBJECTIVES: The objective of this review was to assess the specific effects of placental cord drainage on the third stage of labour, with or without the prophylactic use of oxytocics. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group Trials register (July 2005), CINAHL (1982 to December 2004) and the National Research Register (December 2004). SELECTION CRITERIA: Randomised trials involving placental cord drainage as a variable within the package of interventions as part of the management of the third stage of labour. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the quality of trials and extracted data. MAIN RESULTS: Two studies met our inclusion criteria in terms of quality and relevance. Cord drainage could impact the third stage of labour as the results show a statistically significant reduction in the length of third stage of labour (one trial, n = 147, weighted mean difference (minutes) -5.46, 95% confidence interval (CI) -8.02 to -2.90). In the incidence of retained placenta at 30 minutes after birth (one trial, n = 477, relative risk 0.28, 95% CI 0.10 to 0.73) a significant difference was found, but this should be interpreted with caution due to potential intervention bias. AUTHORS' CONCLUSIONS: It is difficult to draw conclusions from such a small number of studies, especially where the review outcomes were presented in a variety of formats. However, there does appear to be some potential benefit from the use of placental cord drainage in terms of reducing the length of the third stage of labour. More research is required to investigate the impact of cord drainage on the management of the third stage of labour.

Constriction↗

PubMed1993

Advanced abdominal pregnancy complicated by bilateral ureteral obstruction. A case report.

A case of term abdominal pregnancy is reported. The patient was followed throughout pregnancy, but the diagnosis was made only at the time of laparotomy for elective cesarean section. The report exemplifies the ease with which the diagnosis of abdominal pregnancy can be overlooked and stresses the importance of considering this diagnosis in cases of high maternal serum alpha-fetoprotein. The management of the placenta is also discussed. In this case the retained placenta was managed successfully without intervention despite the unusual complication of bilateral ureteral obstruction. Additionally, the biochemical activity of the placenta was assessed by following the progressive decline of serum human chorionic gonadotropin over time.

Adult↗

PubMed1994

Do uterine leiomyomas influence pregnancy outcome?

To evaluate the clinical significance of the presence, location, size, and number of uterine leiomyomas in pregnancy, a retrospective cohort study in which pregnancy complications and outcome of pregnant women with uterine myomas was undertaken by routine second trimester ultrasound examination. The case group consisted of 183 consecutive women with uterine myomas detected and followed during the years 1983-1989; the control group was made up of all pregnancies diagnosed and followed at the obstetric clinic during the period 1985-1987. The incidences of preterm delivery (less than 37 weeks), preterm premature rupture of membranes, in utero growth retardation (less than 5th percentile), placental abruptio, placenta previa, postpartum hemorrhage (more than 500 cc), and retained placenta were not significantly increased in the group of women with myomas compared with the general population. However, cesarean sections were more common in women with myomas (23 vs 12%; P < 0.001). Within the group of women with myomas, the incidence of cesarean section was not different in cases with multiple rather than solitary myomas, but it was significantly higher in cases of lower uterine segment compared with fundal myomas (39 vs 18%; P < 0.01) and when the mean diameter of the myoma was greater than 5 cm (35 vs 17%; P = 0.01). Stepwise logistic regression analysis showed that both myoma location and size were independent predictors of the odds of cesarean section.

Adult↗

PubMed1982

Management of the third stage of labour in the midwife obstetric units in Cape Town.

A revised scheme of management of the third stage of labour was recently introduced in the Midwife Obstetric Units in Cape Town. Patients received synthetic oxytocin (Syntocinon; Sandoz) 5 IU intramuscularly with the delivery of the anterior shoulder and ergometrine maleate 0.5 mg intramuscularly after delivery of the placenta. A significant decrease in the incidence of postpartum haemorrhage and retained placenta was observed, warranting continuation of the new regimen.

Drug Therapy, Combination↗

PubMed2004

Conservative management of spontaneous uterine perforation associated with placenta accreta: a case report.

BACKGROUND: Placenta accreta occurring in an unscarred uterus is exceedingly rare. Previous cases of spontaneous uterine perforation associated with placenta accreta were treated with hysterectomy. CASE: A nulliparous woman was clinically diagnosed with placenta accreta when spontaneous vaginal delivery was complicated by postpartum hemorrhage and a retained placenta. Magnetic resonance imaging subsequently revealed focal areas of placenta accreta. Acute-onset abdominal pain and cul-de-sac fluid prompted diagnostic laparoscopy, which revealed a spontaneous uterine perforation in the right posterior-lateral aspect of the uterus. This area was oversewn, and the patient received 2 weeks of postoperative antibiotics because of Enterococcus faecalis bacteremia. CONCLUSION: Spontaneous uterine perforation associated with placenta accreta can be managed conservatively.

Adult↗

PubMed1979

Effect of prepartum selenium-vitamin E injection on time for placenta to pass and on productive functions.

The effect of a single injection of selenium-vitamin E containing 21.9 mg sodium selenite upon time for placenta to pass following calving and on subsequent reproductive and lactational performance was evaluated. Incidence of retained placenta was 11.4%. This amount of selenium-vitamin E did not affect the time for placenta to pass, did not reduce calving difficulty, nor did it increase number of heats prior to first breeding, decrease days open or services per conception, or increase milk the next lactation.

Animals↗

PubMed2005

Postpartum hemorrhage after cesarean delivery: an analysis of risk factors.

OBJECTIVE: To determine the incidence and risk factors for postpartum hemorrhage (PPH) associated with cesarean delivery. METHODS: Blood loss at cesarean delivery was measured and defined as 1,000 to 1,499 mL or greater than 1,500 mL and/or the need for a blood transfusion. Variables were identified and evaluated to determine the factors associated with PPH. RESULTS: There were 1,844 elective and 2,993 nonelective cesarean deliveries over 4 years. The PPH rate in nonelective cesarean (6.75%) was greater than after elective cesarean (4.84%, P = 0.007). Risk factors for PPH after an elective operation included leiomyomata, blood disorders, placenta previa, antepartum bleeding, preterm birth, and general anesthesia. Nonelective cesarean PPH risk factors included blood disorders, retained placenta, antepartum transfusion, antepartum/intrapartum hemorrhage, placenta previa, general anesthesia, and macrosomia (odds ratio > 1.5, confidence interval > 1.5). CONCLUSIONS: Nonelective cesarean deliveries have a higher risk of PPH than women delivered electively. Risk factor identification and prevention should be a priority.

Adult↗

PubMed1996

Persistent placenta increta: a complication of conservative management of presumed placenta accreta.

BACKGROUND: Recent reports have advocated conservative management rather than hysterectomy for placenta increta and its related conditions, placenta accreta and percreta. We report an unusual case of placenta increta in which initial conservative therapy for a presumed placenta accreta failed and hysterectomy was performed 6 months postpartum. CASE: A 32-year-old woman, gravida 2, para 2, was referred 5 months after a repeat cesarean delivery and bilateral tubal interruption for evaluation of an intrauterine mass. A presumed placenta accreta noted at delivery had been managed conservatively. Hysterectomy was performed, and pathologic evaluation was consistent with a retained placenta increta. CONCLUSION: Persistent placental tissue is a potential complication of conservative management of an abnormally adherent placenta.

Adult↗

PubMed1993

Dynamic ultrasonographic imaging of the third stage of labor: new perspectives into third-stage mechanisms.

OBJECTIVE: Dynamic ultrasonographic imaging of the third stage of labor was performed to document ultrasonographic findings and to present new perspectives into third-stage mechanisms. STUDY DESIGN: Twenty-five normal deliveries and five with prolonged third-stage labor were studied. RESULTS: Normal third-stage labor could be divided into four phases: (1) latent phase, characterized by thick, placenta-free wall and thin, placenta-site wall; (2) contraction phase, with thickening of placenta-site wall (from < 1 cm to > 2 cm); (3) detachment phase, in which the placenta completes its separation and detaches; and (4) expulsion phase, with a sliding movement of the placenta. Although oxytocic agents were routinely used, they do not seem to influence the findings. In five cases with retained placenta the placenta-site wall was initially thin. In four of them it became thick, and the placenta was removed by traction of the cord, whereas in the fifth case the placenta-site wall remained thin and the placenta had to be removed manually. CONCLUSION: Shearing forces seem to tear the decidual septae and thereby separate the placenta. This process is completed only when the placenta-site wall attains full thickness. In cases of prolonged third-stage labor, traction of the cord should be applied only when this phase is completed and the actual sliding movement of the placenta is observed.

Female↗

PubMed1992

Identification of human satellite DNA sequences associated with chemically resistant nonhistone polypeptide adducts.

A fraction of DNA fragments of highly purified and completely unfolded eukaryotic DNA inevitably remains associated with chemically resistant nonhistone DNA-polypeptide complexes. This fraction can be isolated by nitrocellulose filtration because the polypeptide-associated DNA fragments are retained on nitrocellulose filters while bulk DNA passes through the filters. The fraction of AluI-fragmented DNA from human placenta retained on filters as a result of the binding factors (R-DNA, approximately 12%) represents a subset of genomic sequences with a sequence complexity different from unfractionated DNA and DNA recovered in the filtrate (F-DNA). DNA sequences prevalent in the retained fraction were detected by differential plaque hybridization of a recombinant lambda gt10 library with radiolabeled F- and R-DNA fractions. Several recombinant phages showing much stronger hybridization signals with the R-DNA probe than with the F-DNA probe were selected, plaque-purified and analyzed. Analysis of the inserts of such clones showed that repetitive DNA sequences of the alphoid dimeric and tetrameric family, satellite III and satellite III-like sequences are highly enriched in the retained fraction, which indicates that these sequences specifically attract the polypeptides involved in the tightly bound and resistant complexes. This property of repetitive sequences is of interest since tandemly repetitive sequences have been suggested to code for locus-specific fixation and stabilization of the chromatin fiber in the cell nucleus.

Bacteriophage lambda↗

PubMed1999

Late uterine wedge resection of placenta increta.

BACKGROUND: Recently, preferences for preserving reproductive potential has sparked increasing interest in the conservative management of placenta accreta, increta, and percreta. CASE: A 23-year-old gravida 3 para 2 had a vaginal delivery complicated by retained placenta. The placenta was delivered in multiple fragments followed by sharp curettage. Her postpartum course was complicated by pelvic pain and menorrhagia, unrelieved by sharp curettage. Four months postpartum, transvaginal ultrasonography and magnetic resonance imaging demonstrated an intramyometrial mass. Exploratory laparotomy was done with wedge resection of the anterior wall of the uterus under real-time ultrasonographic guidance. Pathologic examination found placenta increta. CONCLUSION: Conservative management of placenta increta can be used selectively to preserve reproductive potential.

Adult↗

PubMed2006

Morbid adhesion of the placenta after hysteroscopic lysis of intrauterine adhesions.

OBJECTIVE: To report a case of morbidly adherent placenta in a patient who had previously undergone hysteroscopic lysis of intrauterine adhesions. DESIGN: Case report. SETTING: Large district general hospital within the National Health Service in the U.K. PATIENT(S): A healthy 32-year-old woman who had conceived following hysteroscopic lysis of intrauterine adhesions. INTERVENTION(S): Watchful expectancy following the diagnosis of morbidly adherent placenta immediately after delivery. MAIN OUTCOME MEASURE(S): Retention of the uterus and therefore reproductive function. RESULT(S): Successful resolution of the retained placenta following watchful expectancy. CONCLUSION(S): Watchful expectancy is a valid option in the management of a morbidly adherent placenta.

Adult↗

PubMed2002

[MRI of the female pelvis: useful information for daily practice].

The MR findings of non-neoplastic gynecologic diseases were comprehensively reviewed. Pelvic inflammatory disease is a common benign disease affecting reproductive women, in which imaging findings are similar to those of malignant tumors of the adnexa. Torsion or rupture of benign ovarian masses can also mimic malignant ovarian tumors. Diagnostic keys to these conditions are presented in this review. The usefulness of dynamic contrast MRI in diagnosing ectopic pregnancy is also indicated. Placenta accreta is a catastrophic condition that occurs from labor to the postpartum period. Preliminary results of the diagnostic significance of dynamic contrast MRI in differentiating retained placenta accreta and normally attached placenta are also presented. Eclampsia is defined as convulsion complicated with pregnancy and is demonstrated as posterior reversible encephalopathy syndrome on imaging. Some commentary on eclampsia is given together with characteristic MR imaging findings.

Adult↗

PubMed1995

Post partum intra-abdominal hemorrhage due to placenta percreta.

Placenta percreta is a serious complication of pregnancy. A 38-year-old nullipara presented at 25 weeks gestation with preterm labour. Spontaneous delivery was followed by retained placenta. During an attempt to remove the placenta manually placental tissue could not be distinguished. Initially, placenta increta was considered as the most likely diagnosis and conservative management was planned, but progressive shock emerged due to intra-abdominal hemorrhage and laparotomy was performed. Placenta percreta was diagnosed, followed by a supracervical hysterectomy. A review of risk factors, diagnostic tools and treatment possibilities is given.

Abdomen↗