Placenta expulsion

Placenta expulsion refers to the delivery of the placenta from the uterus following childbirth. This process is the final stage of childbirth, occurring after the birth of the baby. It is a critical phase in the postpartum period, as it involves the detachment and expulsion of the placenta, along with the membranes (or amniotic sac) that surrounded the baby during pregnancy. The management and outcome of placenta expulsion are vital for the health and recovery of the mother.

Process

Placenta expulsion can occur naturally, or it may be assisted by medical intervention. The process typically begins within minutes after the baby's birth, with the average time for spontaneous expulsion ranging from 5 to 30 minutes in the third stage of labor. This stage is managed through either a physiological or a managed (active) approach.

Physiological (Natural) Management

In physiological management, the placenta is expelled by the mother's effort without medical intervention. This method relies on the natural contraction of the uterus to separate and expel the placenta. Mothers may be encouraged to breastfeed or have skin-to-skin contact with their baby, as this stimulates the release of oxytocin, a hormone that promotes uterine contractions.

Managed (Active) Management

Managed or active management involves a series of interventions by healthcare providers to help expel the placenta. This may include the administration of oxytocin immediately after the baby's birth, controlled cord traction (gently pulling on the umbilical cord with counterpressure on the uterus), and uterine massage after the placenta's expulsion to encourage the uterus to contract and reduce postpartum hemorrhage.

Complications

Complications associated with placenta expulsion include postpartum hemorrhage (PPH), retained placenta, and placenta accreta. PPH is a significant cause of maternal morbidity and mortality worldwide and can occur if the placenta is not expelled completely or the uterus fails to contract effectively after its expulsion. A retained placenta is when the placenta or parts of it remain in the uterus beyond 30 minutes after childbirth, necessitating medical intervention to remove it and prevent severe bleeding or infection. Placenta accreta is a condition where the placenta attaches too deeply into the uterine wall and does not detach naturally, requiring surgical removal and posing a high risk of PPH.

Management of Complications

The management of complications arising from placenta expulsion involves prompt recognition and intervention. Treatment may include manual removal of the placenta, administration of uterotonic drugs, uterine massage, and, in severe cases, surgical interventions such as Dilation and Curettage (D&C) or a hysterectomy. Ensuring access to skilled birth attendants and appropriate obstetric care is crucial in preventing and managing these complications.

Cultural and Historical Practices

Cultural practices and beliefs surrounding placenta expulsion and the handling of the placenta vary globally. In some cultures, the placenta is considered to have spiritual significance and is buried or otherwise honored in special ceremonies. Historically, the importance of managing the third stage of labor has been recognized for centuries, but practices and interventions have evolved based on scientific understanding and evidence-based medicine.