Manual extraction - page 2

1. 
   Mar 22, '03

   We do those in the OR, with anesthesia. In addition to the anesthesia/pain control issue, you never know the reason the placenta is not coming out on its own (acreta?, etc) or if you will be able to control her bleeding after.
2. 
   Mar 22, '03

   My mother had to have that done after I was born, though we have our feelings on whether it was a stubborn placenta or an impatient doctor. I've read my father's journal entry about it, and it still brings me to tears to read the depth of his feelings of fear and pain for her. The worst part is that the MD left significant amounts of placenta behind and mom ended up with a hemorrhage and a D&C on Christmas Day.
   
   After my miscarriage and hemorrhage last year, the OB did a little probing with a swab and that was enough to make me grip the sides of the bed and cry out...and he is the most gentle doc I've ever encountered. I can't imagine a full extraction without medication.
3. 
   Mar 26, '03

   I have seen a few...the one unmedicated had come in hemorrhaging after giving birth precipitously at home. She was literally climbing up out of the bed.
   
   I've never seen it take 30 minutes, certainly unmedicated...that would be brutal.
4. 
   Mar 26, '03

   Moz! Nice to see ya girl! I was thinking you'd fallen off the face of the earth!
5. 
   Mar 30, '03

   Usually done with strong epidural or spinal anesthesia on board....
   
   but watching it still makes me double-over with severe cramps....
   and MY uterus has been out for five years! LOL!
   
   Haze
6. 
   Oct 4, '03

   To my knowledge, when my wife does these (She's an Ob/Gyn) she puts them out just as cold as they can go and still breathe. If there is time and she expects things to take awhile, she will take them to the OR so they can go completely under.
   
   Side note, she has told me that and epidural will not cut it for this, unless it is super strong. She still loads them up on Fentanyl and VSD.
   
   David Adams, ARNP
   -ACNP/FNP
7. 
   Oct 5, '03

   I have seen this thankfully only once so far, and the patient had a very good labor epid. Anesthesia came and used the same bolus they use for C/S and gave some versed. It helped the patient relax and saved an official trip to the OR, it should have been done in the OR but the point is it worked. The did use a currette as well and patient didn't really feel anything, and thankfully didn't remember the experience either.
8. 
   Oct 5, '03

   I have waited 90 minutes for a placenta before. most of our practitioners prefer to wait PATIENTLY for that placenta.
9. 
   Oct 5, '03

   BETSRN:
   WOW! Most of the practitioners have an AMI when we hit 20 minutes and act at 30...I guess fearing an acreta, sometimes wish they would have more patience.
   
   Question: How is the patient's bleeding at this point?
10. 
    Oct 27, '03

    I saw one of these last week, on my first clinical day in L&D, first delivery I ever attended. I was completely horrified. Mom had NO meds on board and none werre ordered before extraction. The Doc (Used to be my Dr. actually, until I saw this) waited 22 minutes, then went in and got it. I have never seen anyone try to climb up a wall backwards.
    
    I asked the nurse if they would usu. do this after only 22 min. and she said, Well, if it doesn't come then they have to get it out don't they? I looked at the delivery summary, the blood loss was est. at 300cc's, that's normal for a NSVD, right? The babe had been dx'ed with a congenital brain anomaly by ultrasound- and the Doc wasn't sure she saw 3 vessels in the cord. Would this have made her suspect accreta?
    
    I didn't have the nerve to ask the Dr. about it because it upset me so much, so I am still wondering about it. I hope I never have to witness that again.
    
    Kim
11. 
    Oct 30, '03

    I have yet to see a manual extraction following a SVD. The only time I have seen it, was on a CS pt, who had a strong spinal and was sedated. Her placenta looked like hamburger meat.
12. 
    Nov 3, '03

    Actually had this happen last night after yet another precip, doc came to deliver placenta (that wasn't in nearly a rush as the baby) After trying with just stadol and phenergan anesthesia was called for conscious sedation. Prior to anesthesia arriving mom was actually holding up pretty good with the doctors efforts. It is a hard thing to watch and you have to wonder "what" is making it so hard to come out? That is the thing that scares me.

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