An approach to detection of placental separation and expulsion with new clinical signs: A study based on hemodynamic method and ultrasonography

Abstract

Since the conventional methods of detecting placental separation in the third stage of labor have not proved to be entirely reliable, a new method based on hemodynamic principles was developed with the use of signs which permit a more accurate assessment. This method consists of clamping the cord immediately after delivery of the neonate, pinching the cord on the placental side between the thumb and fingers, then squeezing the blood in the cord toward the placenta for a distance of approximately 10 to 15 cm. By sensing the presence or absence of backflow pressure in the cord while slowly loosening finger pressure on the cord, the state of the placenta can be assessed. This method and the criteria applied have been used in approximately 2,100 deliveries at St. Luke's international Hospital over the past 10 years, and assessment has revealed that the elicited signs correlated well with serial ultrasonographic findings and appeared distinctly and earlier than other signs conventionally followed. Moreover, the subsequent progress toward expulsion of the placenta could be determined through palpation. Thus, the obstetrician's routine use of this simple method may be helpful in the assessment of the state of placental separation and expulsion.