Gynaecology and Obstetrics Section

 RETENTION OF FETAL MEMBRANES

Fetal membrane are normally shed within 2 – 6 hrs after expulsion of fetus. If the fetal membrane are not expelled even after 12 hours it is termed as retained fetal membranes.

Treatment

•  Manual Removal
• This remains a common practice and manual removal can result in more frequent and severe uterine infection. One hand is inserted between the endometrium and chorion in the inter cotyledonary space and individual fetal cotyledon and its caruncle are grasped gently , squeezed and with thumb and fore fingers and the two structure are gently separated by a rolling, pushing and squeezing motion. This may be aided by traction with the other hand on the adjacent portion of the fetal membranes as the separation is completed. The cotyledons in the cervical area of the uterus are removed from the caruncles first and then from the middle portion of the horn and then from the  non gravid horn.

Manual removal of the placenta should not be done when there is systemic illness.

The use of anti microbial therapy in the treatment of retained fetal membrane could control local bacterial growth, but actually it interferes with the necrotizing process that is responsible for eventual release of retained fetal membranes.

•  Ecbolic Drugs
• PGF2 _a and oxytocin could be effective in treating retained fetal membrane because of uterine atony.
• However uterine atony accounts for a very small percentage of retained placenta cases.
• Calcium borogluconate 300 to 450 ml intravenously  
•  Collagenase Type-XI – This is done by injecting 200,000 units of collagenase Type – XI dissolved in 500 ml of Saline within 25 mins into the umbilical artery. The cost required for purchase of collagenase may preclude its use.
•  The best treatment option would be to allow separation of placenta by natural process of expulsion.
•  In retain placenta prevention is better than cure since many common therapy have not been shown to be effective.
• Prevention can be done by  Reducing stress around parturition.
•  Nutritional management during pregnancy 
•  Supplementation of Vit E and Selenium.