What are the effects of manual removal of adherent placenta?

Manual removal of adherent placenta is a common procedure after childbirth and may lead to various complications, including uterine bleeding, uterine wall injury, risk of infection, intrauterine adhesions, and potential endometriosis. The severity of these complications is closely related to the degree of placental adhesion. A detailed analysis is as follows:

1. Uterine bleeding: During the removal process, the decidua or myometrial blood vessels may be damaged, leading to hemorrhage. In cases of mild adhesion, blood loss is usually minimal. However, with severe adhesion, the procedure becomes more difficult and may cause extensive vascular damage, resulting in heavy bleeding. Severe cases may require blood transfusion or additional surgical intervention to control bleeding.

2. Uterine wall injury: Improper use of instruments or technique during the procedure may cause mechanical damage to the uterine wall, such as myometrial laceration. Minor injuries can heal spontaneously, but severe cases may result in uterine perforation, causing intense abdominal pain. Emergency surgical repair is required; otherwise, it may endanger the patient's life.

3. Risk of infection: The removal procedure disrupts the natural protective barrier within the uterus, increasing the risk of bacterial invasion. If postoperative hygiene is inadequate or if there is pre-existing genital tract inflammation, bacteria may proliferate in the uterine cavity, leading to endometritis or pelvic inflammatory disease. Symptoms may include fever, abdominal pain, and abnormal lochia.

4. Intrauterine adhesions: The wound surface on the uterine wall caused by removal may develop tissue adhesions during healing, potentially leading to partial or complete occlusion of the uterine cavity. These adhesions can affect subsequent menstruation, causing reduced menstrual flow or amenorrhea, and may interfere with embryo implantation, increasing the risk of infertility or recurrent miscarriage.

5. Risk of endometriosis: During manual removal, endometrial tissue may be displaced into the myometrium or other areas of the pelvis via blood flow or surgical manipulation. These ectopic endometrial tissues may bleed cyclically in response to hormonal changes, leading to endometriosis, which can cause symptoms such as dysmenorrhea and chronic pelvic pain.

After the procedure, close monitoring of vaginal bleeding, abdominal pain, and body temperature is essential. Maintain good perineal hygiene and avoid tub baths and sexual intercourse. Nutrition should be enhanced, with increased intake of protein-rich foods to promote uterine recovery.