Management of the third stage of labor by a midwife. Methods for isolating separated placenta

What is afterbirth or children's place? This is the placenta, membrane and umbilical cord, that is, the placenta with all its membranes and umbilical cord. The placenta plays a very important role in the development of the embryo. He performs following functions:

• Protective. It protects the fetus from the mother's blood antibodies and at the same time prevents the fetal antibodies from entering the mother's blood. In fact, it does not allow an immunological conflict between the body of the mother and the child. Plus, it doesn't miss some medicines, which the mother may take, or bacteria during colds women.
• Endocrine. Produces biologically active substances, as well as hormones that are necessary for the development of the embryo.
• Gas exchange. Transports oxygen from the mother's blood while carbon dioxide brings out.
• Nutritious. Provides the embryo with the substances necessary for development.

The placenta is an embryonic organ that is formed and exists only during pregnancy. After birth, it must be separated by uterine contractions and abdominals and then exit naturally. But sometimes this doesn't happen. This depends on many reasons, such as weak muscles press or various pathologies.

After the baby is born, the placenta separates, which was attached to the wall of the uterus throughout pregnancy. This one is natural physiological process should proceed independently and begin immediately after birth.

The birth itself is divided into three main parts. These are contractions, the birth of a baby and the birth of a child's place. This process should take no more than 30 minutes, during which time several painless contractions occur and the uterus is completely emptied due to the release of the placenta. This is where the name of this embryonic organ comes from, because it is the last to leave the uterus. After release, the placenta is examined for the presence of pathologies and broken vessels. Sometimes it may be sent for histological analysis.

Signs

There are several main signs of separating a child's seat:

• Schroeder's sign. It lies in the fact that the condition, height and shape of the uterus changes. It becomes flatter, its bottom rises, and the organ itself deviates to the right side.
• Alfred's Sign. It consists in the fact that the free end of the umbilical cord is noticeably lengthened. After childbirth, the cut umbilical cord is grabbed with a clamp, and after the separation and, accordingly, descent of the placenta occurs, the cord itself is lengthened.
• Mikulicz sign. It lies in the fact that the woman in labor feels contractions, that is, the urge to push. But this symptom does not appear in all women.
• Klein's sign. It lies in the fact that during pushing, the length of the umbilical cord does not change; accordingly, the baby's place is not attached to the wall of the uterus, but has already separated and lies freely without any attachment.
• Klyuchter-Chukalov sign. It lies in the fact that when you press on the suprapubic area, visible part The umbilical cord lengthens, and after pressing the umbilical cord remains motionless.

Separation methods

There are several methods of external stimulation of the child's seat compartment:

• Abuladze method. Manipulations should begin with emptying the bladder. Then you need to do a gentle massage of the uterus. Then grab abdominal wall for the longitudinal fold. In this case, the discrepancy between the muscles should be eliminated, and the size of the abdomen should decrease. Next, the woman in labor should push hard. This method is quite effective and painless.

• Genter's method. In this case, the afterbirth is, as it were, squeezed out. First you need to empty bladder. The gynecologist then presses his hands, folded into fists, onto the mother's abdomen, thereby surviving the placenta. This method is quite traumatic, so the doctor’s experience and great caution when carrying out this manipulation are very important.
• Credet-Lazarevich method. As a rule, it is used if other methods have been ineffective. First, the bladder is emptied, and then the uterus is massaged. Next, the doctor places his hand on the bottom of this organ so that one finger rests on the front wall, and four fingers on the back wall. During these manipulations, the doctor squeezes the uterus, presses on it and thus pushes out the placenta.

If the previous methods did not help, the placenta is manually separated.

It is practiced only when it is impossible to perform it in any other way and with heavy bleeding when every minute counts. This procedure must be carried out in compliance with all safety and antiseptic measures. The gynecologist should clean the hands up to the elbows and wear sterile gloves. Then process antiseptic solution the patient's labia, pubis and inner thighs. Cover the woman's belly with a sterile diaper and only then begin the procedure.

It is performed either under general anesthesia or with the help of painkillers. The doctor inserts one hand into the uterine cavity, and with the other hand he presses on the abdominal wall from above. When the site of attachment of the embryonic organ to the uterus is detected, the doctor separates it with saw-tooth movements. The separated embryonic organ must be removed with the left hand, but the right hand must remain in the uterus so that the doctor can examine it for pathologies and damage. And also to make sure that there are no parts of the placenta left in it.

There is no need to confuse manual separation of the placenta and manual separation of the placenta. These are different manipulations. In addition, separation is a rather complex process, while removal of an already separated placenta is not big threat for mother's health.

Pathologies

Now we will try to figure out why the process of separation of such an organ as a child’s place does not occur on time and what pathologies contribute to this delay.

• The hypotonic state of the uterine muscles can cause retention of the placenta.
• Sometimes the cause may be an abnormal location, that is, low attachment of the placenta.
• Presentation is the process by which the placenta descends into the lower segment of the uterus.
• Incrementation is the process of the placenta becoming too attached.
• Tight attachment of an organ such as a child's place differs from an increment only in that the intensity of attachment is slightly weaker.
• Abruption is a pathology in which premature separation of the placenta occurs. In this case, bleeding may occur, which is dangerous not only for the mother, but also for the child.
• Premature maturation or aging of the placenta may indicate serious problems and possible termination of pregnancy.
• Late maturation most often occurs in women with diabetes mellitus and in pregnant women who smoke. This indicates the need to lead a healthy lifestyle.

Video: how the placenta separates

• For first-time women, it is very important to know how or what to do if pregnancy starts.
• In addition, many expectant mothers are tormented by the question of...
• The question of pain relief from contractions, in general and in particular, remains very important.

I would like to ask women who have encountered the problem of separating a child’s place to describe in their comments how midwives helped you. Did you know before giving birth that some problems might arise and did you have the pathologies described in the article?

Childbirth is divided into three periods: opening of the cervix, pushing, during which the fetus is expelled, and the afterbirth. The separation and delivery of the placenta is the third stage of labor, which is the least lengthy, but no less responsible than the previous two. In our article we will look at the features afterbirth(how it is carried out), determination of signs of placental separation, reasons for incomplete separation of the placenta and methods for separation of the placenta and its parts.

After the birth of the child must be born. It is important to note that you should never pull on the umbilical cord to speed up this process. A good prevention of placenta retention is to put the baby to the breast earlier. Sucking at the breast stimulates the production of oxytocin, which promotes uterine contractions and separation of the placenta. Intravenous or intramuscular injection small doses of oxytocin also accelerates the separation of the placenta. To understand whether separation of the placenta has occurred or not, you can use the described signs of placental separation:

• Schroeder's sign: after separation of the placenta, the uterus rises above the navel, becomes narrow and deviates to the right;
• Alfeld's sign: the separated placenta descends to internal os cervix or vagina, thereby lengthening outer part umbilical cord 10-12 cm;
• When the placenta separates, the uterus contracts and forms a protrusion above pubic bone;
• Mikulich's sign: after the placenta separates and descends, the woman in labor feels the need to push;
• Klein's sign: when the woman in labor strains, the umbilical cord lengthens. If the placenta has separated, then after pushing the umbilical cord does not tighten;
• Küstner-Chukalov sign: when the obstetrician presses over pubic symphysis If the placenta is separated, the umbilical cord will not retract.

If labor proceeds normally, then no later than 30 minutes after expulsion of the fetus.

Methods for isolating separated placenta

If the separated placenta is not born, then use special moves to speed up its release. Firstly, they increase the rate of administration of oxytocin and organize the release of the placenta using external methods. After emptying the bladder, the woman in labor is asked to push, and in most cases the placenta comes out after childbirth. If this does not help, use the Abuladze method, in which the uterus is gently massaged, stimulating its contractions. After which the woman in labor is taken with both hands in a longitudinal fold and asked to push, after which the placenta should be born.

Manual separation of the placenta is carried out if external methods are ineffective or if there is suspicion of placenta remains in the uterus after childbirth. The indication for manual separation of the placenta is bleeding in the third stage of labor in the absence of signs of placental separation. The second indication is the absence of separation of the placenta for more than 30 minutes when external methods of separation of the placenta are ineffective.

Technique for manual separation of the placenta

With the left hand they spread birth canal, and the right one is inserted into the uterine cavity, and, starting from the left rib of the uterus, the placenta is separated with sawing movements. The obstetrician should hold the fundus of the uterus with his left hand. Manual examination The uterine cavity is also carried out in cases of separated placenta with identified defects, and in case of bleeding in the third stage of labor.

After reading, it is obvious that, despite the short duration of the third stage of labor, the doctor should not relax. It is very important to carefully examine the released afterbirth and ensure its integrity. If parts of the placenta remain in the uterus after childbirth, this can lead to bleeding and inflammatory complications in the postpartum period.

The third stage of labor is defined from the moment of birth of the child until the separation of the placenta and the discharge of the placenta. Duration 5-20 minutes. During this period, it is necessary to monitor the nature and quantity bleeding from the uterus, signs of separation of the placenta. When signs of separation of the placenta appear, the woman is recommended to push to give birth to the separated placenta, or begin to release it externally.

Signs of placenta separation:

- Chukalov-Kustner – when pressing with the edge of the palm on the uterus above the pubic symphysis, the umbilical cord does not retract into the vagina;

- Alfeld – a ligature placed on the umbilical cord at the genital slit of the woman in labor, with the separated placenta, lowers 8–10 cm from the vulvar ring;

- Schroeder – change in the shape and height of the uterine fundus. The fundus of the uterus rises up and is located above and to the right of the navel.

- Dovzhenko – the woman in labor is asked to take a deep breath and if, when inhaling, the umbilical cord does not retract into the vagina, then the placenta has separated.

Application of external methods for removing separated placenta:

- Abuladze's method – grab the abdominal wall in a longitudinal fold with both hands and offer to push. The separated afterbirth is easily born.

- Genter's method – the fundus of the uterus leads to midline. The doctor stands on the side of the woman in labor, facing her feet. The hands, clenched into a fist, are placed with the dorsal surfaces of the main phalanges on the bottom of the uterus, in the area of ​​its corners, and gradually press on it downward and inward. With this method of releasing the placenta, the woman in labor should not push.

- Crede-Lazarevich method - the uterus is brought to the midline position, light massage they try to cause its contraction and then they clasp the fundus of the uterus with their hand so that thumb was on the anterior wall of the uterus, the palm was on the bottom, and four fingers were on back wall uterus. After this, the placenta is squeezed out - the uterus is compressed in the anteroposterior direction and at the same time pressure is applied to its bottom downward and forward along the axis of the pelvis.

At normal course During the afterbirth period, blood loss averages no more than 0.5% of body weight. This blood loss is classified as physiological, since it does not have any effect negative influence on the mother's body. Maximum acceptable blood loss V physiological childbirth– no more than 500ml.

After birth, the placenta should be external massage uterus and make sure there is no bleeding. After which they begin to inspect the placenta to ensure its integrity.

Having ensured the integrity of the placenta, determine its mass and the size of the maternal surface area of ​​the placenta. The weight of the placenta during full-term pregnancy is 1/6-1/7 of the fetal weight; on average 400-600 g. The mature placenta has the form of a disk with a diameter of 15*20 cm and a thickness of 2-3 cm. The surface of the lobules of the maternal part of the placenta is smooth and shiny.

Maintaining postpartum period.

Immediately after childbirth, early postpartum hemorrhage may occur, most often associated with uterine hypotension. Therefore, for the first 2 hours the postpartum woman is in maternity ward, where the condition of the uterus, the amount of discharge from the genital tract, and hemodynamic control are monitored.

To prevent bleeding in the early postpartum period, all postpartum women need timely emptying of the bladder with a catheter, external reflex massage of the uterus, and cold on the lower abdomen. Active management III period labor is indicated at increased risk postpartum hemorrhage and in women with complications (severe anemia). Currently with for preventive purposes recommended intravenous administration oxytotic drugs (oxytocin, ergometrine, methylergometrine, syntometrine, syntocinon) in primiparas during eruption of the head, in multiparas - during cutting. If there are no signs of placental separation 10-15 minutes after the birth of the child, even if methylergometrine was administered intravenously for prophylactic purposes, intravenous drip administration of oxytocin is indicated. If, despite the administration of oxytocin, there are no signs of placental separation and external bleeding, then 30-40 minutes after the birth of the fetus, manual separation and release of the placenta is indicated.

Principles of management of the succession period:

Emptying the bladder immediately after birth;

Monitoring maternal hemodynamic parameters;

Control of blood loss;

In the normal course of labor after the birth of the fetus, any mechanical impact on the uterus (palpation, pressure) until signs of placenta separation appear is prohibited.

If, after the appearance of signs of separation of the placenta, its independent birth does not occur, then techniques for releasing the placenta can be used to reduce blood loss.

Techniques for isolating separated placenta.

1. Abuladze’s maneuver (Fig. 40) After emptying the bladder, the anterior abdominal wall is grasped in a fold with both hands. After this, the woman in labor is asked to push. The separated placenta is born as a result of increased intra-abdominal pressure.

2. Genter's maneuver (Fig. 41) - pressure from the fundus along the ribs of the uterus downward and inward (not currently used).

3. Crede-Lazarevich maneuver (Fig. 42) empty the bladder with a catheter; bring the fundus of the uterus to the midline position;

perform light stroking (not massage!) of the uterus in order to contract it; clasp the fundus of the uterus with the hand of the hand that the obstetrician controls better, so that the palmar surfaces of its four fingers are located on the back wall of the uterus, the palm is at the very bottom of the uterus, and the thumb is on its front wall; simultaneously press on the uterus with the entire hand in two intersecting directions (fingers - front to back, palm - top to bottom) towards the pubis until the placenta is born.

The Credet-Lazarevich method is used without anesthesia. Anesthesia is necessary only when it is assumed that the separated placenta is retained in the uterus due to spastic contraction of the uterine os. In the absence of signs of placental separation, manual separation of the placenta and release of the placenta are used. A similar operation is also performed if the postpartum period continues for more than 30 minutes, even in the absence of bleeding.

Rice. 40. Reception of Abuladze

Rice. 41. Genter's reception

Rice. 42. Reception of Crede-Lazarevich

After the birth of the fetus, intrauterine pressure increases to 300 mm Hg, which is many times higher than the blood pressure in the myometrial vessels and contributes to normal hemostasis. The placenta contracts, the pressure in the umbilical cord vessels rises to 50-80 mm Hg, and if the umbilical cord is not clamped, then 60-80 ml of blood is transfused to the fetus. Therefore, umbilical cord clamping is indicated after its pulsation has stopped. Over the next 2-3 contractions, the placenta separates and the placenta is released. After the birth of the placenta, the uterus becomes dense, round, located in the middle, its bottom is located between the navel and the womb.

Childbirth is a difficult and responsible period not only for mother and child, but also for doctors. The birth process is divided into 3 stages: preparation, pushing and childbirth, separation of the placenta. The third stage is very important, since the health of the new mother depends on it. Ideally, the “baby spot” should calve in a timely manner and completely; if this does not happen, then doctors resort to manual expulsion. Any anomalies of the placenta provoke inflammatory process and severe bleeding.

Afterbirth - description and structure of the organ

The placenta (baby place) is an embryonic organ that exists only during the period of bearing a child. This is very important organ which provides nutrition, respiration and normal development embryo. In addition, the afterbirth protects the child from various kinds harmful effects. The question of what the afterbirth looks like interests many. Externally, the organ resembles a cake, and inside it there is a membrane that connects circulatory system mother and embryo.

Composition of the placenta:
Placenta
Umbilical cord
Membrane (aqueous, villous, decidual).

The chorionic villi attached to the uterus form the placenta. The placenta with all its membranes is the afterbirth. The placenta has 2 surfaces: external and internal. The outer (maternal) is adjacent to the wall of the uterus, it consists of lobules (from 15 to 20 pieces), which are covered on top with a gray membrane. Each lobule is pierced by villi through which blood vessels pass.

The inner (fruit) surface is adjacent to the fertilized egg, and a water membrane envelops it on top. The fruit surface is covered blood vessels, which rush to the root of the umbilical cord, attached to the center of the inner surface of the placenta.

From the inside, the uterus is covered with 3 membranes: maternal (decidual), fetal (chorion), internal (amnion). Inside the amnion is amniotic fluid in which the embryo floats. The aqueous membrane envelops the placenta and the umbilical cord. The fruit and water membranes are separated from each other.

The umbilical cord connects the embryo to the placenta. There are 2 umbilical arteries passing through the umbilical cord, through which the deoxygenated blood and a large vein that transports oxygen and nutrients to the fruit. Around the vessels there is germinal tissue (Wharton jelly), which protects them from compression by tissues.

Amniotic fluid fills the fertilized egg and protects the embryo from injury.

The placenta is fully formed at the 16th week of pregnancy, and from the 36th week it begins to age. If the pregnancy proceeds normally, then the weight of the fetus is from 3.3 to 3.4 kg, the size of the placenta is 15–25 cm, and the thickness is from 2 to 4 cm. Question: “How much does the placenta weigh?” is of interest to expectant and new mothers, as well as doctors. Normally, the weight of the organ is approximately 500 g.

Functions of a child seat

The placenta of pregnant women is an important organ that performs the following functions:

Gas exchange. The placenta transports oxygen from the mother's blood into the fetal bloodstream, and carbon dioxide is removed to the outside with the help of maternal red blood cells. With stenosis or blockage of blood vessels, the child suffers from oxygen starvation, due to which its development is disrupted.

Nutritious. The placenta provides nutrition to the embryo, metabolites are transported back, and this is how the excretory function manifests itself.

Endocrine. The placenta produces hormones and biologically active substances that are necessary for the pregnant woman and the fetus ( human chorionic gonadotropin, placental lactogen, estriol, progesterone). Based on the concentration of these substances, the condition of the placenta can be assessed and pathologies in the development of the embryo can be identified.

Protective. The placenta protects the fetus from the mother's antibodies and also prevents the penetration of embryonic antigens into the mother's blood. In this way, the organ prevents an immunological conflict between the two organisms. However, the placenta is not able to protect the fetus from drugs, alcohol, nicotine and viruses.
If the development of the placenta is disrupted, complications that are dangerous for the mother and child arise.

Possible problems associated with the placenta

One of the most common pathologies of the placenta is low placental attachment. If the problem is determined after the 28th week of pregnancy, then we are talking about placenta previa, which blocks the os of the uterus. However, only 5% of women retain this arrangement until 32 weeks.

Placenta previa is a dangerous complication of pregnancy in which the placenta moves to the lower segment of the uterus. This pathology occurs in repeat births, especially after abortion and postpartum complications. Complications can be caused by neoplasms, abnormal development of the uterus, low implantation ovum. Placenta previa increases the risk uterine bleeding and premature birth.

Placenta accreta is a condition characterized by tight attachment of the placenta to the uterus. Because of low position placenta chorionic villi grow into the myometrium or into the entire thickness of the uterus. As a result, the afterbirth does not come off on its own.

Tight attachment differs from the previous pathology only in that the chorionic villi grow to a shallower depth into the uterine wall and provoke retention of the placenta. In addition, this anomaly provokes bleeding during childbirth. In both the first and second cases, they resort to manual separation of the placenta.

Placental abruption is a pathology that is characterized by premature (before the birth of the child) separation of the placenta from the wall of the uterus. In this case, the uteroplacental vessels are damaged and bleeding occurs. The intensity of symptoms depends on the area of ​​detachment. For small detachments, shown natural childbirth followed by examination of the uterine cavity. In case of severe detachment, a cesarean section is indicated.

Premature maturation of the placenta is characterized by early maturation or aging of the organ. In this case, the following types of placenta are observed:
Thin - less than 2 cm in the 3rd semester of pregnancy. This problem is typical for gestosis, intrauterine retention, and threatened miscarriage.
Thick – more than 5 cm at hemolytic disease and diabetes mellitus.
It is necessary to carry out diagnosis and treatment.

Late maturation is more often diagnosed in women with diabetes mellitus, pregnant women who smoke, in cases of Rh conflict between mother and child, and congenital anomalies fetal development. A small placenta is not able to perform its functions, and this threatens stillbirth and mental retardation of the child. Increased risk of placental infarctions, inflammation of the placenta or fetal membranes (eg, ascending bacterial infection placenta stage 3), as well as placental neoplasms.

Birth of a child's place

The phrase: “The placenta passed away after childbirth” confuses many first-time women. After all, the 3rd stage of labor, when the placenta is born, is also very important, this is how the uterus is cleansed. Doctors monitor the woman, assess her condition, monitor her heartbeat and try to determine how much blood she has lost. To assess the degree of blood loss, a metal bowl is placed under the woman. It is important to empty your bladder regularly so that it does not retain the placenta.

After about 2 hours and blood loss of no more than 220 ml, the afterbirth comes out. In case of bleeding and retention of the placenta, external expulsion of the organ is performed. It is very important to completely remove the afterbirth after childbirth, because even a small piece of it can cause dangerous complications: severe uterine bleeding or purulent infections.

Signs of placenta separation

The process of separation of the baby's place from the umbilical cord and fetal membranes is called the birth of the placenta. There are several characteristic features placenta compartments:

Schroeder's sign - the condition, shape and height of the uterus changes. When the placenta separates, the uterus becomes flatter and its bottom rises towards the navel. The uterus deviates to the right side.

Alfred's sign - the free end of the umbilical cord lengthens. After the baby is born, the umbilical cord is crossed, and its other end goes into the vagina. The doctor places a clamp on its end. When the placenta of a woman in labor descends into bottom part uterus, the umbilical cord also lengthens.

Mikulich's sign is the urge to push. This symptom does not appear in all women giving birth.

Klein's sign - after pushing, the umbilical cord, which protrudes from the vagina, lengthens. If, after the end of pushing, the length of the umbilical cord does not decrease, then the placenta has separated from the uterus.

Klyuster-Chukalov sign - when you press on the suprapubic area, the umbilical cord lengthens. After graduation physical impact the umbilical cord remains motionless.
If at the 3rd stage of labor the woman in labor feels normal, the placenta has not separated, and there is no bleeding, then the waiting period is extended to 2 hours. If after this time the mother’s condition has not changed or even worsened, then the placenta is removed manually.

Methods of expelling a child's place

The succession period takes little time, but this does not reduce its complexity. At this stage, the risk of uterine bleeding increases, which threatens the woman’s life. After all, if the baby’s place is not born, then the uterus can no longer contract, and the blood vessels do not close. Then doctors use emergency methods placenta compartments:

Abuladze method. The doctor performs a gentle massage of the uterus, then grabs the abdominal wall by the longitudinal fold and asks the woman in labor to push. External separation of the placenta using the Abuladze method does not cause pain; it is quite simple and effective.

Genter's method. The fundus of the uterus is brought to the midline. The doctor turns sideways to the woman so that he can see her legs, clenches his hands into fists, and presses the back surface of the main phalanges to the fundus of the uterus. The physician applies gradual pressure, moving the placenta down and inward. The woman in labor should not push.

Credet-Lazarevich method. This method is used if previous methods were ineffective. The fundus of the uterus is brought to the middle position, and its contractions are stimulated with the help of a light massage. Then the obstetrician should stand on the left side of the woman so that he can see her legs and grasp the fundus of the uterus right hand so that 1 finger rests on its front wall, the palm on the bottom, and 4 fingers on the back surface. The physician then squeezes out the placenta by squeezing the uterus with one hand while pushing out the placenta with the other.
This effective ways placenta compartments, which are used if the baby's place has separated from the uterus on its own. In this case, the doctor simply facilitates his exit.

If there is bleeding without signs of placental separation or the absence of these signs within 2 hours after birth, the doctor performs manual expulsion of the placenta. This is dangerous and complex procedure during which anesthesia is used.

Inspection of the placenta

The question of what to do with the placenta after childbirth interests many women. First of all, the afterbirth is submitted for histology to ensure its integrity. After all, as already mentioned, even a small part of it that remains inside can provoke inflammation. The organ is laid out on a tray with the maternal surface facing up and the lobules are examined. Particular attention should be paid to the edges; the child's place should be smooth, without torn vessels.

Then the afterbirth is turned over with the fruit surface up, and the shell is carefully examined. The doctor should straighten each tear and carefully examine the villous membrane for damage to blood vessels.

Histological examination of the placenta makes it possible to restore clinical picture, identify its presentation. If, as a result of examining the placenta, it turns out that the organ has not come out completely, then the uterus is cleaned. This procedure is carried out manually or using a curette (special spoon).

Examination of the placenta after childbirth can even reveal fetal membranes that are retained in the uterine cavity. In this case, no cleansing is carried out, the membranes come out along with the lochia (postpartum discharge).

After examination, the placenta is weighed, the data is recorded in a chart, and the woman in labor is given a conclusion on the examination of the placenta. After the above procedures, the placenta is disposed of.

Then the doctor assesses the blood loss, examines the woman’s birth canal, rinses it with an antiseptic solution, and stitches up the tears. Then the woman in labor is sent to the postpartum ward, where her condition is monitored for another 3 hours. This is explained by an increased risk of bleeding after childbirth due to decreased uterine tone.

Prevention of placenta retention is timely treatment chronic diseases, management healthy image life during pregnancy planning and during gestation. Besides, future mom should allocate at least 10 hours for sleep, avoid excessive physical activity, stress, walking on fresh air at least 4 hours, eat right. It is important to avoid crowded places and take multivitamin complexes.

Thus, the afterbirth is a temporary but very important organ that connects the body of the mother and the fetus, performs respiratory, nutritional and protective function. Timely and correct separation of the placenta guarantees the successful completion of childbirth and the absence of health problems in the future.