Retained placenta: Delivery by the hydraulic method (Mojon-Gabastou injection)

Abstract

1.1. Retained placenta is a disagreeable, frustrating, and dangerous complication which requires prompt solution.2.2. Manual removal of the placenta is not an innocuous procedure to be undertaken lightly in all circumstances. While its mortality has been greatly improved in recent years, manual removal still carries the dangers of rupture of the uterus, inversion of the uterus, shock, hemorrhage, and infection.3.3. The hydraulic method (Mojon-Gabastou injection) is recommended as a safe, simple substitute for manual removal, which makes it possible to deliver the retained placenta without invading the uterine cavity with the hand. The placenta is briskly injected through the umbilical cord vein with 500 c.c. of hot sterile normal saline solution, which stimulates the uterine expulsive mechanism.4.4. The hydraulic method has been found successful in 70 to 90 per cent of retained placentas in large series of cases reported by various authors. Its occasional failure does not further complicate the case or interfere with manual removal. In fact, manual removal is made easier due to the increased firmness and thickness of the placenta.5.5. The hydraulic method should be used early, not after many hours or several days of retention of the placenta. In such cases the chance of success is slight due to clotting of the blood in the placental blood vessels.6.6. The hydraulic method is indicated in (a) retained placenta with no bleeding and (b) retained placenta with only slight bleeding. It must not be used where retained placenta is associated with profuse bleeding or shock due to previous blood loss. Immediate manual removal is the only rational means of treating profuse bleeding caused by retained placenta.7.7. The Credé method, with or without anesthesia, is not recommended for the treatment of retained placenta. It is traumatic, shocking, and too often it is unsuccessful. Should waiting and simple expression fail, the hydraulic method should be used. If the hydraulic method fails, manual removal of the placenta is the next step.8.8. The hydraulic method is the treatment of choice for retained placenta in the presence of eclampsia because the eclamptic patient withstands general anesthesia and shock poorly.9.9. The hydraulic method is the treatment of choice for retained placenta in the presence of prolonged rupture of the membranes and intrauterine infection because it does not stir up the infective process as does manual removal of the placenta.10.10. The hydraulic method is useful not only in the hospital delivery room but should be very useful in rural areas.