What to do if the afterbirth comes out incomplete?
If the incompleteness of the placenta was noticed during the inspection of the afterbirth that has already taken place, the rest of the afterbirth must be removed by a doctor. The active substance oxytocin can be used to increase the uterus‘ ability to contract and to facilitate placental dissolution. The doctor can also manually try to remove the remains of the afterbirth with a finger.
There is also the procedure of freretage, in which any remaining remains in the uterus are scraped out with the help of a blunt instrument. Even a full bladder can obstruct the dissolution and discharge of the placenta. A catheter can then be inserted to drain the urine and facilitate the passage.
However, in some cases, incomplete placental dissolution alone is not the only complication requiring treatment. The remnants of the remaining placenta can bleed heavily and thus become a vital threat to the mother. The loss of blood must therefore be brought under control as quickly as possible.
When attempting to stop the bleeding, there are a number of steps to be taken, whereby pressure is applied to the uterus and the vessels to reduce the blood flow. It is also possible to try to stop the bleeding by using a special balloon that is inserted into the uterus. An attempt to manually dissolve the placenta or curettage the uterus can be used to loosen and remove the placenta as a source of bleeding.
In extreme cases, if haemostasis is insufficient, a hysterectomy, i.e. removal of the uterus, is the last possible treatment option. In some cases, the placenta has anomalies that affect its adhesion to the uterus and cause the placenta to dissolve incompletely or not at all. Here, too, attempts are made to remove the remnants of the afterbirth manually or by means of a curing procedure.
If the placenta has completely grown together with the uterus or even penetrates it, the entire uterus is removed. If only very small remains remain in the uterus, which do not cause any discomfort, and the mother is breastfeeding, it is also possible to wait. The hormone oxytocin, which is released during breastfeeding, causes the uterus to contract and can thus promote the dissolution of the remains.
