Signs and Release Mechanism Placenta

According to ( Sastrawinata , 1983 ) Signs of placental detachment there is often a sudden gush of blood , the uterus becomes globular and more solid consistency , the uterus rises toward the abdomen because the placenta that had run down into the vagina , as well as the umbilical cord is out longer . After the attachment of the placenta separates from the pressure exerted by the placenta cause the uterine wall slid toward the bottom of the uterus or upper vagina . Sometimes, the placenta can get out of this location by the presence of inter - abdominal pressure . However , the woman lying in a supine position often can not remove the placenta spontaneously . Generally , it takes action to enhance artificially high stage of labor . The usual method is done by pressing and mengklovasi uterus , along with a light tug on the cord .
Factors Affecting the Release of Placenta : 1 ) abnormalities of the uterus itself , ie anomalies of the uterus or cervix ; weakness and ineffectiveness of uterine contractions ; tetanic contractions of the uterus , as well as the formation of ring constriction . 2 ) abnormalities of the placenta , such as low-lying placenta or placenta previa ; implantation in the horn , and the presence of placenta accreta . 3 ) Error management of the third stage of labor , such as manipulation of the uterus that do not need prior to the release of the placenta causing rhythmic contractions ; improper administration of uterotonic time which can also cause cervical contraction and hold the placenta , as well as anesthesia especially debilitating uterine contractions .The mechanism of placental separation
The contractions of the uterus will reduce uri area , because the walls of the uterus become smaller and grow a few centimeters thick . Contractions had caused the loose and weak parts of the uri and the wall of the uterus , this section will be separated , at first partially and then completely and live freely in the uterine cavity . Sometimes it would be a small fraction uri is still attached to the uterine wall .
This release process is usually gradual and blood pengumpulann behind uri uri will membantuh release . When the release is complete , the uterine contractions push the placenta that has been released into the lower uterine segment , then kevagina and born .
The amniotic membrane was removed , in part by the contraction of the uterus , partly as uri discharge . In places that telepas bleeding between the placenta and decidua basalis , called retroplasenter hematoma ( Mochtar , 1998) . According to ( Sastrawinata 1983 ) . There are two methods for removal of the placenta :
a. Schultze method
The method is more common , the placenta separates from one point and slipped into the vagina through a hole in the amniotic sac , the fetal surface of the placenta appears at the vulva with membranes that follow behind like an umbrella upside down while peeling away from the wall of the uterus . Maternal surface of the placenta and the blood clot does not look to be in the bag upside down , contraction and retraction of uterine muscles that cause separation of the placenta is also firmly pressing the blood vessels and control bleeding . It could be because there are oblique muscle fibers in the upper uterine segment
b . Duncan Matthews method ,
Down through the placenta and into the side of the vulva with a first lateral barrier such as clothing fasteners are entering the hole , the placenta is not part of the sac . In this method the possibility of remaining parts of the membranes greater because the membranes are not chipped all complete Schultze method . This method is associated with a low-lying placenta in the uterus . Release process lasts longer and so much blood lost ( because there is little oblique fibers in the bottom segment .The mechanism of removal of placenta
Placenta that has been separated by uterine contractions that will be driven down by the uterus is now regarded as a foreign object . This is also aided by the abdominal pressure or straining , then the placenta to be born , 20 % spontaneously , and the rest need help . There are 3 maneuvers to determine the release of the placenta :
a. Kustner
By putting pressure on the hand with / above symfisis , the cord stretched, then when entering the umbilical cord is not yet detached , silent or advanced means it regardless .
b . His KleinSewaktu there , we push a little womb , when the umbilical cord back means the placenta has not detached , detached placenta or fall silent .
c . Strassman
Flex cord and word of the fundus , when the vibrating cord marked yet detached placenta , the placenta has been marked not vibrate loose. Normally , the placenta release ranged ¼ - ½ hours after the child was born , but we can wait a maximum of up to 1 hour . But if there is a lot of bleeding or if the labor - delivery and no history of postpartum hemorrhage , it must not wait , you should immediately dikelurkan placenta by hand . Also if bleeding is more than 500 cc or one nierbekken , the placenta should be removed manually indirectly ( Mochtar , 1998) .