What to do if the placenta adheres to the uterus

Adhesion between the placenta and the uterus needs to be treated according to the degree of adhesion, which mainly includes manual removal of the placenta, drug treatment, hysteroscopic surgery, uterine artery embolization, hysterectomy, etc. Placental adhesion may be related to factors such as endometrial damage and abnormal attachment of the placenta.

1. Artificial removal of placenta

It is suitable for cases of mild adhesions. The doctor can separate the placenta and uterine wall with bare hands after delivery. The operation must be strictly aseptic to avoid violent traction that may cause uterine perforation. Vaginal bleeding and uterine contractions need to be monitored after surgery, and oxytocin injection should be used to prevent bleeding if necessary.

2. Drug treatment

For some cases of placenta accreta, methotrexate tablets can be used to inhibit the growth of trophoblast cells, and mifepristone tablets can be used to block the effect of progesterone. During medication, it is necessary to regularly monitor blood β-HCG levels and ultrasound changes, and be alert to adverse reactions such as drug-induced liver injury.

3. Hysteroscopic surgery

For focal adhesions, an electric cutting ring can be used to accurately separate them under direct vision of the hysteroscope, and an intrauterine device can be placed after surgery to prevent re-adhesion. This method can preserve fertility function, but serious conditions such as placenta percreta need to be ruled out.

4. Uterine artery embolization

Interventional technique is used to embolize the uterine artery to reduce the blood supply to the placenta, which is suitable for difficult-to-control bleeding during cesarean section. Post-embolization syndrome such as fever and pain may occur after surgery, and prophylactic antibiotics such as cefuroxime axetil tablets are required.

5. Hysterectomy

When placenta percreta occurs with massive bleeding, a subtotal hysterectomy is required, using a stapler such as the Johnson & Johnson Ethicon cutting stapler. This is the ultimate treatment and will result in permanent loss of fertility.

Postpartum perineal care needs to be strengthened and disinfected with iodophor solution 2-3 times a day.； No bathing or sex within 6 weeks ； Observe the changes in lochia characteristics and seek medical attention immediately if fever, abdominal pain or abnormal bleeding occurs. The diet should be supplemented with high-quality protein such as fish and soy products, and animal livers should be eaten in moderation to help hematopoiesis, and avoid raw, cold and spicy food. You can perform Kegel exercises to strengthen your pelvic floor muscles, but avoid lifting heavy objects and other behaviors that increase abdominal pressure.