Abstract
Introduction: Retained placenta is one of the causes of postpartum haemorrhage in Bangladesh as it is worldwide and a common problem faced by the department of obstetrics. Objective: To determine the clinical presentation of patients admitted with retained placenta at the Dhaka Medical College Hospital, Dhaka, Bangladesh. Material & Methods: This was a cross-sectional study which was carried out in the department of Obstetrics and Gynaecology, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh, during the study period from January 2010 to June 2010. A total number of 50 cases were selected for the study. The data were collected by pre-designed questionnaire; relevant information was collected by direct interview of patients and relatives. Statistical analyses were carried out by using the Statistical Package for Social Sciences version 16.0 for Windows (SPSS). Results: Mean age was found 27.04±3.48 years with range from 20 to 36 years. Home delivery was found in 31 (62.0%). Mean duration of retained placenta was found 3.0±0.58hrs with range from 2.30 to 4.3hrs. Mild per vaginal bleeding was found 4 (8.0%), Moderate P/V bleeding was 42 (84.0%) and severe bleeding was 4 (8.0). Regarding past history, patients with myomectomy was found 1 (2.0%), cesarean was 3 (6.0%). H/O retained placenta was 9 (18.0%). H/O MR was 24 (48.0%) and D&C was 18 (36.0%). Primi para was found 2 (4.0%) and multi para was 48 (96.0). Moderate anaemia was found 41 (82.0), normal temperature was 49 (98.0%), mean pulse was 91.0±8,13 beats/min mean systolic BP was found 91.9±6.81 mmHg and mean diastolic BP was 57.6±5.55mmHg. From P/A examination of the study patients it was found that, atonic uterus was 29 (58.0%), tenderness was 2 (4.0%), more than three fourth 76% was with full urinary bladder, mean height of uterus was 22.24±1.6 weeks. Moderate per vaginal bleeding was 41 (82.0%), vaginal full with clot was 41 (82.0%) and OS was open in 46 (92.0%). Mean Hb% was found 8.25±0.85 gm/dl with range from to 7 to 9.2gm/dl. Conclusion: The incidence and severity may be decreased by health education, women empowerment and the provision of facilities for essential obstetrics services by high skilled health care providers in ensuring a properly conducted delivery with discharged after timely effective management.
Highlights
Retained placenta is one of the causes of postpartum haemorrhage in Bangladesh as it is worldwide and a common problem faced by the department of obstetrics
Regarding P/A examination of the study patients, atonic uterus was 29 (58.0%), tenderness was 2 (4.0%), more than three fourth 76% was with full urinary bladder, mean height of uterus was 22.24±1.6 weeks
In the study of Chhabra et al, (2002)2 showed 36.61% women had come in state of severe stock. In this current series it was observed that all patients received antibodies, among them injection ciprofloxacin injection metronidazole received 76.0%, blood transfusion received 94.0%, oxytocin 98.0%, prostaglandin 96.0% and controlled cord traction was done in 6.0%. It was observed in this current study that, 94.0% of the patients need manual removal of placenta, deep sedation was given to 48.0%, analgesia was given to 12.0% and anesthesia was given to 46.0% and 2.0% underwent hysterectomy
Summary
Objective: To determine the clinical presentation of patients admitted with retained placenta at the Dhaka Medical College Hospital, Dhaka, Bangladesh. The present study attempts to show the management of the patients who will be admitted with the retained placenta at Dhaka Medical College Hospital. Retained placenta is potentially life-threatening because of retention per se, but because of associated haemorrhage and infection as well as complications related to its removal [2] These risks are increased in women in poor social circumstances due to pre-existing, malnutrition, anaemia and unsupervised home deliveries. Nikolajsen et al [3] estimated the prevalence and validate the diagnosis of retained placenta in nulliparous women and the risk of re-occurrence at subsequent vaginal delivery. This study intends to determine the clinical presentation of the patients admitted with retained placenta at the Dhaka Medical College Hospital, Dhaka, Bangladesh
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