Childbirth takes place in two stages - the birth of the child and the release of the placenta. If the baby's place does not come out on its own, there is a suspicion that parts of the placenta and membranes remain in the uterus, so curettage or vacuum cleaning is indicated. It's simple but pretty painful procedure, as a result of which it is carried out after preliminary anesthesia immediately after childbirth, over the next 24 hours, the first or second postpartum months. Why can’t you do without cleaning, and what are the possible complications after it?
In what cases is cleaning necessary after childbirth?
It happens that during childbirth the placenta comes out partially or remains completely in the uterus. In this case, the obstetrician immediately decides to manually scrape the uterine cavity or perform vacuum aspiration to clean the muscular organ. Before leaving maternity hospital(on days 3-5) young mothers undergo a control ultrasound.
The reasons why parts of the placenta remain in the uterus are low activity of the walls and bending of the muscular organ. When the examination shows the presence of blood clots and placental remnants, signs inflammatory process, cleaning is also carried out. The young mother remains in the hospital for another 1-2 days.
Failure to perform timely curettage will sooner or later lead to hospitalization. This is fraught with the following consequences:
- uterine bleeding with a drop in hemoglobin levels, weakness, inability to care for the baby;
- inflammation of the endometrium;
- sepsis - a general infection of the blood, which leads to infection of the uterus.
The best time to cleanse is immediately after giving birth. However, it also happens that it is prescribed 6-8 weeks after natural delivery or caesarean section due to the appearance of spotting or bleeding.
Cleaning technique
Cleaning the uterus after childbirth, while its throat is open, is the optimal period for intervention. In this case, manual cleaning is possible, which involves instrumental curettage under anesthesia. In some cases, vacuum aspiration is performed. After such a procedure, the young mother stays in the maternity hospital for 1-2 days.
If the obstetrician is sure that after birth the baby's place is completely out, a heating pad with ice is placed on the stomach. Then every day at the clinic they do intramuscular injections oxytocin. The substance provokes active contractions of the uterus, allowing the organ to quickly return to its prenatal state. In this case, the doctor feels the abdomen every day and inquires about the volume. postpartum discharge. A control ultrasound before discharge shows whether curettage is necessary.
If, according to the results of a control ultrasound, cleaning after childbirth is necessary, the woman will stay in the maternity hospital for a couple of days. The procedure algorithm is no different from an abortion:
- use of general or local anesthesia;
- treatment of the external genitalia with antiseptics;
- mechanical expansion of the cervical canal;
- carefully removing clots and parts of the placenta from the uterine cavity using a sterile curette.
The uterus is cleaned for no more than 15-30 minutes; the young mother recovers gradually from modern anesthesia, without headaches or other side effects. To enhance contractility uterus injections of oxytocin or similar drugs. Normally there should be no bleeding, only lochia. The volume of discharge will gradually decrease, and over time it will turn pale.
In a public maternity hospital, the cost of cleaning is covered compulsory medical insurance. In a private hospital you will have to pay from 7 to 20 thousand rubles for the procedure. (depending on the level of the institution, the anesthesia used and drug treatment during the recovery period).
Cleaning the uterus can be replaced by lavage, which begins the day after delivery. The course includes 3-5 procedures. The task is to remove the remaining clots and carry out antiseptic treatment of the cavity of the muscular organ. The manipulation is carried out under local anesthesia after exposure of the cervix using speculum. Lavage is carried out in two ways:
- Aspiration. To the system intravenous infusion connect a silicone tube through which a washing solution (antiseptic, enzyme, antibiotic, anesthetic) is pumped into the cavity. Contents are extracted using an electric aspirator through an expanded channel.
- By gravity. Instead of a silicone tube, a rubber catheter is used. The contents of the uterine cavity come out by gravity.
Rehabilitation period and ways to speed up recovery
The recovery period after curettage is about 2 weeks and coincides with the rehabilitation period after delivery. The condition of the young mother is monitored by a doctor; his task is not to miss the onset of the inflammatory process.
During recovery, the use of anti-inflammatory, painkillers, antispasmodics and other drugs is indicated. The doctor selects the type of medications, their dosage and course of administration individually. The weakened condition of the patient after childbirth, the level of hemoglobin in the blood, and general well-being are taken into account. During therapy breast-feeding temporarily stopped. Lactation is stimulated through breast massage and pumping. This will help quickly establish feeding the baby after discharge from the hospital.
In order for the recovery process to be successful, the young mother should take into account the following recommendations:
- do not visit the sauna, bathhouse, or take a bath for 3 months;
- observe the rules of intimate hygiene;
- exclude swimming in open waters;
- do not use tampons, only pads, which need to be changed regularly;
- exclude intimacy and physical exercise within 1.5 months.
If cleaning is carried out correctly and in a timely manner, there is no need to be afraid of complications. The main thing is to follow the doctor’s recommendations and be sure to undergo a follow-up examination.
Possible complications after curettage
The main criteria for a successful curettage:
- absence of inflammatory process. what the ultrasound results confirm;
- normal body temperature, which does not rise above subfebrile values (37.5);
- the general satisfactory condition of the young mother, slight dizziness and weakness are possible as a result of the interventions performed;
- a nagging, mild pain in the lower abdomen that gradually goes away;
- absence of scarlet bloody discharge; normally, lochia may be present - minor discharge that becomes paler over time and completely disappears within 6 weeks.
About complications and the need for additional medical intervention testify:
- severe uterine bleeding, in which sometimes it is necessary to make a decision about hysterectomy;
- hematometer - absence of lochia after cleaning (indicates a poorly performed operation and accumulation of secretions in the organ cavity);
- decreased contractility of the uterus;
- an unpleasant odor of discharge is a sign of tissue infection;
- high body temperature, feverish condition.
The doctor performs curettage after a cesarean section with particular care, taking into account the fact that the integrity of the muscular organ is compromised. For this reason, the uterus recovers more slowly and contracts worse. It returns to its previous state 2 weeks after birth, and the stitches take a little longer to heal.
Ultrasound on the 3rd day after surgery allows you to assess the condition of the muscle organ. Swelling of the postoperative scar may indicate endometritis, which is treated with medication. Despite the fact that during a cesarean section, doctors carefully clean the uterine cavity, sometimes an ultrasound shows the presence of clots. If placenta particles or endometrial growth are detected, cleaning is performed under anesthesia. It is recommended to plan the next pregnancy after 3 years.
Poor scraping can lead to health problems in the future. It negatively affects future fertility and leads to adhesions in the pelvic area. Subsequently, there may be difficulties with conceiving and bearing a baby, hormonal imbalances that lead to fibroids, cysts and other gynecological pathologies.
No one is immune from complications during manipulation. Surgery can reduce the risk of their occurrence an experienced doctor using modern equipment. In this case, the endometrium will quickly recover, and a new pregnancy is possible in the next ovulatory cycle. During lactation it is difficult to miss, and if the spouses do not plan to have children, it is better to take care of contraception.
Once, having read on “Internet” forums the frightening stories of experienced mothers about special cleaning after childbirth, I myself came to a disappointing conclusion: the less you know, the more soundly you sleep. However, then, after thinking a little, I realized that such information received simply from the forum was catastrophically insufficient for my sound and restful sleep. It is quite natural that the cleaning necessary after childbirth is an unpleasant manipulation, and what also hurts is that this is a kind of ending to the most important and trembling moment in the life of any woman. And in fact, all those women who once experienced a similar condition are sometimes unable to restrain their emotions, which is precisely why their stories may well be regarded as “horror stories” called “only, not for the faint of heart.” At the same time, we will add: these stories are not for pregnant women.
But in order not to be at all afraid of such a postpartum cleansing and not even think about it (after all, just because you read this article does not mean that you will specifically need one), you need to try to get as much quality, reliable and reliable information about such a cleansing as possible. medical information, and not at all information “from personal experience seasoned and already frightened mother.”
When might it be necessary to cleanse after childbirth?
Doctors, jokingly, say that every woman always gives birth twice (meaning in one visit to her maternity hospital): first a baby, and then the placenta itself (or placenta), in which the baby remained for the entire nine long months of pregnancy. Many women don’t even notice the birth of the placenta, because at this very time they are already busy actively looking at their baby, who has quietly buried his very small nose in his mother’s warm breast. However, this is not always the case, and, of course, this is to our great regret. Sometimes it happens that it is too tightly “attached” to the uterus and is born, as they say, “partially” or cannot come out at all. But in such cases, doctors should perform manual separation of the placenta or placenta, which, among other things, should always be carried out after the caesarean section procedure.
As a rule, immediately before discharge from the maternity hospital (and this is on the 2nd or 3rd day), each woman who has given birth undergoes a planned diagnostic ultrasound. This is necessary in order to timely assess the condition of the entire internal cavity uterus after childbirth. And if the doctor, during such an examination, discovers traces of the placenta or placenta in the uterine cavity, or perhaps simple blood clots, then such a woman in labor is prescribed postpartum cleansing.
How is postpartum cleansing performed?
"Cleaning" on modern " medical language” means banal as in an abortion. This procedure may well be familiar to all those women who have had an abortion at least once in their lives. As you understand, curettage from the mucous membrane of a woman’s uterus is a special operation, which usually involves purely mechanical removal of a certain functional layer of the uterine uterus. And from the germinal layers of the same endometrium, soon after such curettage, a completely new healthy mucous membrane will grow.
Most often, they try to carry out such cleaning only under general anesthesia and, of course, in a standard gynecological chair. Immediately before such an operation, all external genitalia must be treated with the usual alcohol solution iodine, but only 5%, but the vagina and the cervix are treated with a 50% solution ethyl alcohol. Next, using previously inserted dilators of various diameters directly into the cervical canal, they try to expand and remove all remnants of the so-called placental tissue. Moreover, such removal is usually performed using a special blunt curette, and sometimes using an obstetric curette with special teeth. This operation usually lasts no more than twenty minutes.
How should you behave immediately after cleaning?
Let us immediately note that immediately after such a cleansing, a woman in mandatory will have to be under the strict supervision of doctors who will monitor her body temperature, pulse rate, and, of course, the discharge appearing from the genitals. In addition, a woman should treat her external genitalia with special antiseptic solutions at least twice a day.
Immediately after such an operation, you will not be able to use regular vaginal tampons, douche, take a hot bath, visit saunas or steam baths, lift any weights, or even play sports, and this ban will last for two whole weeks. Vaginal sex will also be contraindicated at this time, and this is prohibited only because the woman’s cervix itself will remain open all this time, and quite a lot of erosion will be observed directly on the mucous membrane of the uterine walls. And this, as you understand, can become truly favorable conditions for acute development any infections that your sexual partner can “bring” to you.
But to prevent inflammation, and other real complications possible after such a cleansing, the woman is prescribed antibiotics. It should be noted that the scraping procedure itself is quite painful, which is precisely why it is already postoperative period a woman may experience some painful sensations, and always of varying intensity. During this period, you may well be prescribed a drug such as no-spa, this is only necessary to prevent the sudden development of hematometra (a condition when blood clots are retained in the uterine cavity).
What complications may occur after cleaning?
Actually, a hematometra is precisely the most common complication after a not entirely successful curettage. This condition It may well arise due to too strong compression (or spasm) of the woman’s cervix itself, which will subsequently become the cause of such retention of blood clots directly in the uterine cavity. And it’s worth remembering that stopping any bleeding after childbirth too quickly is the most main symptom occurrence of hematomas. But in order to be able to support your cervix in its completely relaxed position, doctors prescribe the usual No-shpa, as was mentioned a little earlier.
Going further, another common complication of such postpartum cleansing is excessive uterine bleeding, however, we hasten to reassure you, they are indeed extremely rare (and mainly only in those women who have some disorders of normal blood clotting). In cases of penetration of any microbes directly into the uterine cavity after such postpartum cleansing, the following may well occur. dangerous disease like this infectious inflammation the entire mucous membrane of the uterus itself.
It is worth noting that all of the complications described above, of course, will require a strictly defined adequate and timely treatment, which, by the way, can only be prescribed to you by an experienced gynecologist treating you. And “ideally” it would be after such cleaning for literally a few hours that quite abundant bloody issues, which would be with blood clots, and that they would soon become less and less abundant. In addition, after such curettage, for at least ten days, rather scanty, as if spotting, bloody, possibly brown or even yellowish discharge from the vagina.
As we can see, the cleaning procedure itself after childbirth is not so scary at all, especially if you follow some fairly simple rules your personal hygiene and strictly follow your doctor's instructions. Therefore, there is definitely no need to worry about this procedure! After all, it is quite possible that in your particular case everything will work out without it!
During labor female body is exposed to enormous stress and in some cases complications may arise that require additional medical intervention. Cleaning after childbirth is medical procedure, based on the extraction of blood clots or placental remnants from the mucous layer of the uterus, which helps prevent complications and preserve women's health.
The birth process occurs in two stages: first the baby appears, and then the afterbirth comes out - a membrane that surrounds the child for 9 months intrauterine development. However, in cases where childbirth occurs in an unnatural manner, with complications, curettage is performed. Reasons that explain why it is necessary to carry out this procedure, can be:
- After the birth of the child, the placenta did not come out or came out partially.
- Presence of infection in the vagina.
- Insufficient contractile activity of the vaginal muscles.
- Excessively tight attachment of the placenta to the walls of the organ.
- C-section.
The remaining pieces of the placenta can provoke inflammation of the inner layer of the uterus, which can lead to a serious illness - endometritis.
Therefore, in no case should you neglect the recommendations of doctors, and if there is a need for surgical intervention, then it is better to agree to it!
How it happens
In frequent cases, women in labor are injected with oxytocin to stimulate contractile activity of the uterus. This drug is administered to speed up the process of separation and removal of the placenta. This standard procedure, which does not provide negative influence on the body of a woman and a newborn. But sometimes this is not enough, and doctors have no other option but to cleanse.
When a woman after giving birth (especially if it is her first) hears: “It is necessary to cleanse,” she is seized with panic. She doesn’t understand why this procedure is needed, and most importantly, how it happens and whether it hurts.
Before being discharged from the maternity hospital, the woman in labor is examined in a gynecological chair. Screening may also be performed after the baby is born. If blood clots are detected as a result, then vacuum or manual cleaning is prescribed after childbirth.
Like any surgical intervention, curettage requires preparation. Typically, this procedure is prescribed on the eve of the start of natural menstruation. Before the operation, the patient undergoes a thorough examination and undergoes a series of tests. On the day when the operation is to be performed, she is advised to refuse to eat and try to consume as little liquid as possible.
Manual cleaning after childbirth is carried out by scraping, the placenta is removed from the mucous tissue, that is, done mechanically, and vacuum cleaning is done using a special device, its tube is inserted into the vagina and operates on the principle of a vacuum cleaner. Of course, the curettage procedure is very painful, but modern science has stepped far forward, which makes it possible to use wide range painkillers. Therefore, gynecological curettage is performed under anesthesia - general or local.
Before this manipulation, the external organs are lubricated with an iodine solution, the cervix and vagina are disinfected with a solution of ethyl alcohol. The cervical canals are then enlarged and special instruments are inserted to remove the clots. The total duration of the operation is no more than 20 minutes.
Contraindications and consequences
Cleaning the uterus after childbirth, like other surgical interventions, cannot be performed if any inflammatory processes occur in the woman’s body, other than those that caused this manipulation.
As a rule, there are no serious consequences of curettage in women. But it is worth remembering that the guarantee of a successful result of this gynecological surgery is that it must be held in an official medical institution, qualified specialists.
Most women experience spotting after curettage, which may resemble menstruation. The duration of bleeding is different for everyone, which is determined by individual characteristics body, the rate of regeneration of mucous membranes. It is normal if blood is released from the vagina for no more than 10 days in moderate quantities and without unpleasant odor. As during menstruation, the amount of discharge gradually decreases and completely disappears. May also be felt nagging pain lower abdomen and lower back.
However, if the surgical intervention was performed incompetently or negligently, then the woman may face consequences such as:
- Bleeding for more than 10 days. The cause may be: tissue remains in the genital organ; if surgery is performed in the middle menstrual cycle, hormonal disbalance.
- Tears of the cervix or damage to its walls, with the formation of through defects, occur when the forceps are not firmly fixed due to the low elasticity of the organ. A surgical suture may be applied.
- Hematometra is a disease caused by blockage of the uterine cavity with blood clots due to the closure of the cervical canal. It has the following symptoms: fever, severe pain in the lower abdomen, cessation of natural bleeding after gynecological manipulation.
- Endometritis - infectious disease, the cause of which is the vital activity of streptococci and other pathogens due to poorly processed surgical instruments and tissue particles left behind. Accompanied by bloody discharge with a pungent odor, pain in the lower abdomen and fever.
- Infertility is the most terrible consequence that can be caused by negligence or insufficient professional qualifications of medical personnel.
After the operation, the following recommendations should be followed;
- avoid intimacy within a month;
- do not use vaginal tampons;
- do not lift heavy objects and avoid excessive physical activity;
- do not take blood thinning medications;
- refrain from visiting the pool, do not steam or take hot baths.
How to treat the consequences
It is quite possible to avoid cleaning after childbirth. Doctors may prescribe droppers or injections that stimulate the contractile activity of the organ, during which all blood clots and remnants of the placenta will be released. But if given medicinal method turns out to be ineffective, then you will have to resort to surgical intervention.
In some cases, the consequences of curettage require additional attention and treatment. If intrauterine bleeding occurs, it must be stopped immediately to avoid the development of anemia. To do this, the doctor prescribes medications that stop the bleeding and contract the uterus. If the consequence is the development of infection, the patient is prescribed a course of antibiotics. Repeated scraping is also not excluded. Hormonal imbalances are treated by an endocrinologist through medication
In addition to taking medications,
Namely: beef liver, beets and beet juice, pomegranates, avocados, nuts, honey.
Upon completion of the procedure, the patient should adhere to all recommendations received from the doctor regarding the medication regimen and observe the rules of personal hygiene of the intimate area. You also need to carefully monitor your health in case of fever, severe pain in the lower abdomen and lower back, you should immediately consult a doctor.
Childbirth occurs in three periods: contractions, birth of the fetus and birth of the placenta. The placenta is the placenta and membranes that contain the fetus. After the birth of the placenta, there should be no remains of it in the uterus, as well as blood clots attached to its walls or blocking the outflow of secretions; cleansing should be complete. All these tissues will rot in the uterine cavity after childbirth, creating a breeding ground for numerous opportunistic and pathogenic microflora living on the surface of the body.
Blood clots remaining in the cavity can interfere with its cleansing after childbirth - the removal of lochia - postpartum discharge - from its cavity. A blood clot can also block a vessel in the wall, and then break off after a while, causing heavy bleeding. Such bleeding can begin suddenly even a month after birth.
In order to prevent such consequences, they perform cleaning (curettage, curettage) of the uterus after childbirth. If parts of the placenta and fetal membranes remain in its cavity, curettage is carried out immediately after childbirth or within 24 hours after it. If there are blood clots in the uterus that interfere with the cleansing of its cavity, curettage is carried out according to indications, depending on the woman’s condition, but no later than the first week of labor. Availability of indications for curettage in modern clinics confirmed ultrasound examinations(ultrasound).
The operation is simple, but painful, so it is performed under anesthesia. The doctor uses a medical instrument (curette) to scrape out the mucous membrane of the uterus, removing its upper functional layer along with the remains of birth tissue. Sometimes vacuum cleaning is carried out followed by ultrasound control.
Important! If the doctor considers cleaning necessary, the woman should not refuse it!
The main criteria for the success of uterine cleansing
The success of the curettage operation after childbirth is indicated (this is worth remembering!):
- absence of a significant increase in the body temperature of the postpartum woman (the norm is up to 37.5˚);
- no bleeding, moderate bleeding for several days (sometimes up to a week) is considered normal; it gradually turns brown and then becomes lighter; the discharge does not have an unpleasant odor;
- pain in the lower abdomen - it gradually decreases, but persists until the uterus contracts completely;
- the woman’s general condition is satisfactory, but slight dizziness may bother her; All these symptoms indicate that the cleansing is going well.
It is important to pay attention to following symptoms and report them to your doctor:
- increased bleeding;
- complete absence of discharge in the first days after cleansing with a simultaneous increase in pain; this indicates a violation of purification;
- the discharge becomes unpleasant putrid smell– a sign of infection;
- The temperature rises to 38˚ and above.
How is rehabilitation and recovery going?
For some time (4-6 days) after cleaning, the postpartum woman remains in the hospital under the supervision of a doctor. He conducts daily inspections to ensure timely detection possible complications. Drug treatment is prescribed:
- medications for contraction of the uterus - this is the prevention of repeated bleeding;
- antibiotics - to prevent the development of infections.
If rehabilitation period passes normally, the woman is discharged 5-6 days after cleaning, and further observation a doctor is monitoring her condition antenatal clinic. Discharge after curettage (the same as after childbirth) continues for about 6 weeks, gradually becoming lighter and decreasing in volume. Two months after birth, complete cleansing and restoration occurs.
Complications and consequences after uterine curettage
As with any other operation, complications are possible. Complications can be early or late. TO early complications relate:
- bleeding due to damage to a vessel located in the wall of the uterus; in this case, heavy bleeding may be from the genital tract, or may manifest itself in the form of hemometra - accumulation of blood in the uterine cavity due to the closure of the exit from the cavity; To prevent hemorrhage, antispasmodics are prescribed - medications that relieve spasms of smooth muscles;
- perforation (violation of the integrity) of the uterine wall with a sharp instrument - a small puncture can heal on its own, but a large one is sutured; unpleasant consequences, as a rule, does not happen.
These consequences are eliminated on the operating table or with repeated surgery within the first 24 hours. Modern clinics have every opportunity to cope with such consequences.
Hormonal disorders and disruption of the menstrual cycle can be a consequence of too deep curettage of the walls, when not only the upper functional (regenerating) layer of the endometrium is removed, but also the lower, basal layer, which cannot be restored. This complication is difficult to treat and most often causes infertility.
It’s not hard to guess how much anxiety and worry expectant mothers experience during pregnancy and on the eve of childbirth. Stories from friends who have already gone through maternity ward, sometimes feel like a horror movie retelling. And if there is mention of cleaning the uterus after childbirth with a huge metal spoon, then some people begin to desire that this pregnancy will miraculously resolve.
Sometimes you get the impression that everyone will have to go through this execution after giving birth. Is it so?
Childbirth is a physiological process
Knowledge of the physiology of childbirth and the sequence of its stages greatly reduces the feeling of fear and anxiety before the upcoming visit to the maternity hospital. Hour X will come, and labor will begin, regardless of your emotions. Of course, they will proceed much more comfortably if the fear of the unknown gives way to expected situations.
Childbirth consists of three stages:
- Disclosure period. The period of cervical dilatation is the longest - approximately 8-12 hours. Usually, primiparous women are slightly longer than multiparous women. It begins with the first regular contraction and ends with complete dilatation of the cervix. At this time, the fetus descends with its presenting part (and in 95% of births this is the head) to the pelvic floor. At the end of this period, the amniotic sac bursts and clear amniotic fluid flows out.
- The period of expulsion of the fetus, or the pushing period. The pelvic floor muscles are rich in nerve endings, so irritation by their head causes straining - involuntary contractions of the striated muscles of the body. The duration of pushing does not exceed 2 hours. From the moment they begin, the midwife will ask you to lie down in bed, and during the cutting in of the head, she will ask you to go to birth table to the delivery room. From now on, dressed in sterile clothing, she will be at your feet. Listen carefully to the midwife's commands - she is the one who is now managing the birth. It is she who is destined not only to be the first to see the birth of your baby, but also to provide him with some help in this difficult process and protect your birth canal from any tears your baby may cause you. She will cut the umbilical cord, show your long-awaited baby, and place him on you for a closer acquaintance and the first attachment to the breast. The second period is over.
- Succession period. The third stage of labor has arrived. It seemed that everything was behind us, but it was during this period that complications could occur that would require that very cleansing of the uterus.
the trail period lasts up to 30 minutes. The midwife works with your baby, performing his first newborn toilet, tells you his height and weight, and puts bracelets on your and baby’s hands. Not gold or silver - just pieces of oilcloth indicating the date, time of birth, gender, weight and height. The doctor continues to lead the birth. In the third period, through contractions, the placenta should separate from the wall of the uterus and the afterbirth (baby place) should be released along with all the membranes. It is strictly forbidden to force this process by pressing on the uterus. The doctor stands nearby and watches for signs of placental separation. Seeing them, he releases the afterbirth by pulling the umbilical cord. The birth is over.
Complications of the 3rd period
30 minutes have not yet passed, but heavy bleeding has appeared from the uterus, indicating that the process of separation of the placenta has been disrupted. There is only one way out - manual separation of the placenta is necessary. It is performed by a doctor under inhalation or intravenous anesthesia by inserting his hand into the uterine cavity. There is no need to be afraid of this - if the child has already passed, then the doctor’s hand will even more so pass.
Manual separation of the placenta is also performed when 30 minutes have passed and there are no signs of placenta separation. But during these 30 minutes the doctor should not touch the uterus or put pressure on it in order to speed up the 3rd period. Just wait for signs of separation to appear, and then release the placenta by carefully tugging on the umbilical cord.
The placenta is subject to careful examination to determine the integrity of the placenta lobules and membranes.
If there is a defect in the placenta or is suspected, the doctor is required to perform a manual examination of the uterine cavity. Torn membranes are not an indication for this operation.
Early postpartum period
Yes, the birth is over, but we need to make sure there are no ruptures, that is, we need to examine birth canal in the mirrors. The cervix is carefully examined using special instruments, and ruptures are immediately sutured. Tears in the soft tissue of the vagina are also sutured with self-absorbing threads; silk sutures are applied to skin tears, which are removed on the 5th day.
For 2 hours after birth, the postpartum woman remains in the delivery room under observation:
- Monitoring of well-being, pulse rate, blood pressure and the condition of the uterus is carried out.
- She wears an ice pack on her abdomen to maintain uterine hypothermia and prevent uterine bleeding.
This period is dangerous due to hypotonic bleeding, which may require surgery to stop. abdominal cavity and possibly even removal of the uterus.
Cleaning the uterus
During normal course postpartum period In the first 5 days after birth, the uterus continues to contract and involution occurs. This is accompanied by specific secretions - lochia.
If lochia ceases to be secreted, the uterus becomes swollen, like a ball, painful, and the temperature may rise, then this complication is called lochiometra. It occurs as a result of a spasm of the muscles of the cervical canal; the suckers encounter an obstacle to excretion and accumulate in the uterine cavity. Ultrasound confirms the diagnosis.
Lochoimeter is an indication that cleaning is needed after childbirth. IN medical practice there is no such term. Doctors say curettage of the uterine cavity.
How cleaning occurs:
- After childbirth, this operation is performed with a large, blunt curette - a special perforated oval spoon.
- Under intravenous anesthesia, after treating the genitals with an antiseptic solution, the cervix is exposed in the mirrors. The vagina is also sanitized with an antiseptic.
- The neck is fixed by the front lip. If necessary, cervical canal it is expanded with special dilators, after which the lochia is removed with a curette.
- After the operation, uterotonics, antispasmodics, and antibiotics are prescribed.
This procedure is short-term, approximately 15 minutes, but it can delay discharge from the hospital by 1-2 days.
The second situation, when cleaning is performed after childbirth, occurs with subinvolution of the uterus in the postpartum period. Often an obstacle to normal contraction of the uterus after childbirth is the presence of placenta remnants in its cavity. This can happen if you inattentively examine the newborn placenta; for example, you may not notice the absence of the so-called accessory lobe of the placenta. Being in the uterus, it not only prevents its involution, but also contributes to the development of the inflammatory process - postpartum endometritis.
A characteristic feature retention of parts of the placenta during vaginal examination is a patent cervical canal. An ultrasound will also confirm the presence of debris in the uterus.
In this case, cleaning after childbirth will have one feature: the stage of dilation of the cervix will not be necessary, it will be open enough to insert a curette and remove residues. Everything else is exactly the same as with a lochiometer.
If after cleaning the uterus contracts normally, there are no signs of inflammation, then there are no obstacles to discharge from the hospital. One more vaginal exam, one more ultrasound, and get ready to go home with your baby in your arms.
After discharge
If you are one of the “lucky ones” who underwent cleansing after childbirth (and as you can see, this procedure is not done for all postpartum women, but only in the presence of the complications described above), you will be required to strictly adhere to the rules of hygiene of the postpartum period. They are:
- Washing with warm clean water at least 2 times a day.
- Change gaskets as needed.
- No tampons or douching.
- No saunas, hammams, baths, steam rooms or baths. Only showers are allowed.
- Vaginal sex is prohibited.
- Avoid drafts and hypothermia.
- Postpone strenuous exercise and intense sports for at least 2 months.
- Perform a set of gymnastic exercises for newborns every day.
- The pool, swimming in the river and the sea are also not for you.
- Eat a balanced diet. Preference for protein foods, vegetables and fruits, limitation of fatty foods and simple carbohydrates.
- Take vitamin and mineral complexes for nursing mothers.
I would like to believe that you got rid of the habit of drinking alcohol and smoking at least six months before your planned pregnancy. If not, do it immediately.
Visit your obstetrician-gynecologist 5-6 weeks after giving birth to make sure there are no abnormalities. At the same time, discuss issues of future contraception.
As a rule, even a woman’s hard lot of cleaning the uterine cavity does not greatly overshadow the memories of the wonderful days spent in the maternity hospital and associated with the arrival of the baby into this world. And many then want to return there again and again. And there are no obstacles to this. Yes, even though you had your uterus cleaned after childbirth, if you followed all the doctor’s recommendations, then there should be no problems in the future.
