Hellow guys, Welcome to my website, and you are watching MANAGEMENT OF RETAINED PLACENTA DURING LSCS DUE TO POSTEIOR WALL OF THE UTERUS NEAR THE ISTHAMUS.. and this vIdeo is uploaded by Dr Some Gowda, MD, Obstetrics and Gynecology at 2024-10-30T06:34:31-07:00. We are pramote this video only for entertainment and educational perpose only. So, I hop you like our website.
| Name | MANAGEMENT OF RETAINED PLACENTA DURING LSCS DUE TO POSTEIOR WALL OF THE UTERUS NEAR THE ISTHAMUS. |
| Video Uploader | Video From Dr Some Gowda, MD, Obstetrics and Gynecology |
| Upload Date | This Video Uploaded At 30-10-2024 13:34:31 |
| Video Discription | MANAGEMENT OF RETAINED PLACENTA DURING LSCS DUE TO POSTEIOR WALL OF THE UTERUS NEAR THE ISTHAMUS. In the interest of GENERAL CONSULTANTS MANAGEMENT of practical problems arise during primary LSCS in a 32 yrs old pt with Fibroid uterus. After the delivery of the baby one will give Oxitocics and wait till the upper segment wii contract and retract sqize the placenta and push it towards the lower segment as in normal delivery preventing the PPH. Here it was a retained placent in the upper segment ( reason will be discussed later) I try to deliver by traction on cord close to it ,I felt that it was severing ,at this juncture one can try this - After identifying the site of the attachment cord then main mass of the placenta was hold with a sponge holder pulled along with the cord traction in advanced way of traction using multiple sponge holder ( 2 - 3 ) . Same procedure can be followed in case of Normal Delivery instead of difficult MRP with a partial closed os. Pt had USG TWICE during her ANC informing fibroid in the anterio- lateral wall on left side. During LAPROTOMY Fibroid was in the posterior wall near to the isthmus compare to USG FINDINGS . Specificity and sensitivity of once clinical examination will be revealed at time of laparotomy. Specificity and sensitivity of once clinical examination will be revealed at time of laparotomy. Uterus was delivered after closing the lower segment.Anterior wall shows good wrinkles I e ? May not be any fibroid.Similarly posterior wall was explored minimal rugosity was noticed in the lower left of the uterus ? Intra murals ( deep) near to endometrium ?THIS MAY BE THE REASON FOR RETAINED PLACENTA here pushing uterine wall more anteriorly. Plan to do myomectomy thinking that it may cause future disturbance in the defecation and micturation habits impacted in POD. I suggest the consultants ,not to attempt Myomectomy unless they are well versed with the vascularity of the uterus and management of unwanted complications some extent. This diagram gives good idiea regarding the vascularity of the uterus. The myoma recieves blood supply from the periphery from THE ARCUTE AND RADIAL ARTERIES they run mainly in the myometrium. Uterine wall was incised boldly till the pseudocapsule opened so that one will get the correct plane to eneucleated the myoma comfortably with the minimal loss of blood. Here the myoma is in the deeper plane ? Close to the endometrium increases the chances of its opening, PREGNENCY creates good plane but here it is densly adherent to pseudocapsule requires sharp Disection in some areas ? due to Impaction.Fibroid is soft one can not use myoma screw comfertably See I am not ligatted any vessels but caught along with myometrium with the allis space was closed in two to three layers with continuous locking stiches . One can use myoma screw if one feels and comfortable. The dead space was identified by feeling with tip of the finger.One may require two to three layers to obliterate the dead space properly. Uterine suture line after its closure. |
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