Analysis Of Clinical Date Of 44 Patients With Retained Placenta After Vaginal Delivery

Objective:To discuss the pathogeny,conservative management and outcome of retained placenta after vaginal delivery.Methods:A retrospective analysis was performed on 44 patients with retained placenta failed manual removal of the placenta after vaginal delivery with stable vital signs between January 2014 to November 2019 in Second Hospital of Hebei Medical University,and the term gestation were more than20 weeks.They demanded preserved fertility.Results:44 cases with retained placenta were classified into two groups,with or without placenta accreta spectrum disorders according to ultrasound scan?magnetic resonance imaging and clinical manifestation,respectively named group B including 30 cases and group A including 14 cases.In group A,all of the patients were given treatment in average 1.07 days?range 0.1-4?after delivery and the average gestation week of delivery was 30⁺³weeks(range 20⁺¹to 41⁺³).4 cases of placenta delivered spontaneously,3 were removed with manual and 7 cases were managed with curettage.11 patients were given the treatment within 24 hours,including 6 patients who were given transfusion and 2 patients whose blood loss were more than 400ml.In group B,all of the patients were given preserved fertility.They were given treatment in average 17.57 days?range 0.27-44?after delivery and the average gestational week was 29⁺⁴weeks(range 20⁺¹to 41⁺¹).3 cases of placenta delivered spontaneously,4 cases and 5 cases were removed respectively with laparotomy and laparoscopy,15 cases were removed by curettage,and 3 cases were by hysteroscopy.19 of patients?63.33%?had a fever,17 of patients?56.67%?were given transfusion,4 cases?13.33%?whose blood loss were more than 400ml,and 7 cases?23.33%?had delayed postpartum hemorrhage.As blood HCG decreasing,the success rate of curettage increased.Conclusion:The management of retained placenta failed manual removal of the placenta after vaginal delivery should be treated individually.Retained placenta without placenta accreta spectrum disorders usually needs to given promoting uterine contraction,manual removal of the placenta and curettage within a less time after the delivery,which had fewer serious complications.Retained placenta with placenta accreta spectrum disorders were given treatment with curettage 2 weeks later after delivery,while 3 to 4 weeks later after delivery with laparotomy or laparoscopy,which had a high success rate and safe outcome.Treatment within a less time after delivery will cause more blood loss,but treatment in a longer time after delivery will have a higher rate of fever.So,it is necessary to balance the advantages and disadvantages of treatment.In general,choose the treatment opportunity and treament method will get satisfied results.