I deliver placentas in squatting at 5 minutes postpartum, so when the delivery is delayed, it is noteworthy. I delivered a woman who got pregnant with IUD in place. The placenta did not separate for 50 minutes, even pushing in squatting. So, while in squatting i pulled quite hard and even on the cord and finally it started coming down and delivered. The IUD was not in the placenta but in the sac and I think it was stuck into the uterus and that is what made it hard to deliver. Anyone else have this experience?
Interesting but of course a placenta coming with difficultly can happen anyway. On the otherhand damaged endometrium can cause accreta in this case probably over a small surface area
Controlled cord traction in squatting position is not justified. Missed Cu T with pregnancy should be reevaluated in early trimester. Its position should be determined early by USG. Common mistakes occur during its insertion which leads to either perforation; partial or complete, partial incorporation within myometrium.
In your case it was not the Cu T which was responsible for difficulty. Did you retrieve the history of any MTP, interventions before the pregnancy or When Cu T was inserted. Yes, I have experience of several cases. This is not new. In my cases, Cu T was inserted by untrained Midwives in my country. I got a case of bladder stone over a Cu T detected 20 years after its insertion.
I inserted the IUD for this woman 4 years ago, properly and it worked for 3 years. Then she got pregnant. There was no reason to evaluate by ultrasound. I have delivered all her children and she has a negative history , no previous complications with placental delivery. This time I had to apply strong cord traction to get the placenta out. I think it might have been the IUD adhering to uterine tissue as it delivered with the IUD sticking out of the sac, not near the placenta. But i am not sure.
Madam,
When there is contraceptive failure (in case of IUD), USG has to be done to know the position of IUD. Silent perforation followed by migration in surrounding structures should be excluded. The difficulty during placental delivery is only due to attachment of placenta and the decidua, not the membranes. This is simple. There is a clinical guideline to manage the cases of pregnancy, conceived following Cu T insertion.
Once again, CCT in squatting position without fundal support is not recommended. ICM-FIGO 2003.
Have you ever had a woman deliver a placenta in full squat, feet flat on the floor? If you had, you know that there is no need to touch the woman at all. The muscles support the fundus. I encourage you to try my 3,4,5 minute third stage protocol. Completely eliminates PPH.
Madam,
I told you about the guideline. It is not recommended. You did it. That was successful. Congratulation. But ICM does not recommend it. PPH prevention completely depends on how quick and effective the living ligature is. And when and how you are delivering the placenta. We do not attempt physiological management in third stage.
Strong traction on the cord to deliver for delayed placental separation is not recommended ( 50 minutes,). You should always think of morbidly adherent placenta. In this case you may end up with catastrophes. Instead, manual removal can be safe.
I never used strong traction in my life. I have seen several doctors pull the whole uterus out using strong traction. I agree.
When mother is pregnant and IUD in situ, then will you go for hysteroscopy? I am surprised that in a developed country, How mothers could have iatrogenic uterine inversion. When there is misplaced IUD, there is a clinical guideline proposed by experts.
I thought this was a case where the baby had been delivered and the IUD was adherent to the membranes
I can't see any reason for dispute here. The placenta, the membranes & the IUD all delivered. Job well done. Yes i saw IUD getting stuck in the endometrium. I think it just due to scarring to deceidua.
Yes Sir,
There is no dispute. The points declared here are against guidelines.
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