By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Placenta is a structure connected to the fetus in mother’s womb. Fetus derives oxygen and nutrients supplied to it through placenta by the mother. With this, fetus sustains life and grows properly.
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Placenta also removes waste products from baby’s blood. It is attached to wall of womb, internally. Umbilical cord arises from placenta and connects with navel of fetus.
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After delivery of child, placenta too gets expelled. It is separated from child by cutting off umbilical cord. Placenta has to be expelled naturally at delivery, if not it is going to cause trouble to woman. Later, it becomes mandatory to extract it by artificial methods.
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We can find explanation of ‘expulsion of placenta’ given by Charaka, Vagbhata and Kashyapa.
Complications arising due to non-expulsion of placenta
If placenta is not expelled following delivery, it becomes a source of many complications.
The complications of placenta retention are –
Vata, especially sub-type of vata located in abdomen and pelvic regions and controls functions therein, i.e. apana vata is said to be responsible for easy delivery of fetus and expulsion of placenta. This happens if vata is balanced. Retention of placenta is supposed to be caused by vitiated vata. Therefore, first strategy of treating ‘retention of placenta’ would be to suppress vitiated vata. If vata is controlled, placenta is expelled.
Apart from this, retention of placenta should be wisely addressed. This is done by external manipulations and internal medications.
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Woman who has retention of placenta should be held by supporting her back. Navel region of her abdomen should be forcefully compressed. She should be violently waggled. Alternatively, one should give violent jerks by holding both her arms. These maneuvers will help in expulsion of placenta as they create violent movements in abdomen and pelvis.
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Pelvis of woman should be compressed repeatedly by an attendant. Attendant might use her heels to strike or compress pelvis of delivered woman. Use of heels would impart more pressure. Alternatively, attendant may hold woman by both her hips and give violent compression. Jerks and compression of abdomen and pelvis increase intra-abdominal pressure and propel placenta downwards to be expelled.
Vagina should be subjected to proper oleation. After oleation, attendant should induce violent jerks to her flanks. Uterus may be compressed from both sides and placenta delivered completely.
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Inside of throat and palate of woman having retention of placenta should be stimulated by touching it with braid of hair. Alternatively, tip of finger wrapped with hair shall be used to stimulate throat and palate. This produces cough instantaneously and consequentially increase intra-abdominal pressure. This helps in expulsion of placenta.
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Should be done using one or other combination of herbs given below –
using the combination of herbs given below –
All these external and internal interventions may enhance myometrial contractions. With this placenta moves downwards and is expelled.
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When all medicines and methods of expelling placenta fail, it should be manually removed. Physician should first trim their nails. They should lubricate their hand with oil and insert it into vagina. Following umbilical cord, placenta should be extracted by hand.