Immediately after birth, the doctor (or midwife) may have to perform a uterine revision. What does this act consist of? Why is it so important? Is it painful? The answers with Pr Cyril Huissoud, secretary general of the CNGOF, head of the Obstetric Gynecology Service of Croix-Rousse.
What is uterine revision?
Uterine revision is a medical procedure that can occur a few minutes after the delivery stage (expulsion from the genital tract of the placenta and from the membranes initially attached to the uterus). Uterine revision is performed by the obstetrician-gynecologist or midwife in about 5-10% of deliveries. His goal ? Make sure there are no placental fragments, ovular membranes or blood clots. Indeed, it is essential to check that the entire placenta has been expelled, and that the uterine cavity is completely empty after the baby is born.
Why is this an important act?
Leaving a piece of the placenta in the uterus can have serious health consequences for a new mother. " This can cause immediate or secondary bleeding, and there is a risk of infection fairly significant risk of infection since the piece of placenta may be devascularized. In other words, it does not’there will be no white blood cells to fight the’infection. Another possible complication is synechia, which is characterized by abnormal joining of the uterine wall and which can subsequently cause disorders, and in particular fertility problems. », Explains Professor Huissoud. If bleeding occurs, it could also be a rupture of the uterus, in which case uterine revision will determine the cause of the bleeding.
Uterine revision therefore has both a diagnostic and a therapeutic role. The practitioner may have to remove the missing part of the placenta which will allow the uterus to retract better. He may also initiate the necessary treatment depending on the origin of the bleeding.
When is uterine revision done?
Several observations may lead the doctor or midwife to perform a uterine revision to avoid complications.
-On examining the placenta, the professional finds that it is not complete. He will therefore go in search of the missing placental fragment.
– Bleeding appears. " We are checking the cause of the bleeding. In case of’history of surgery such as a cesarean section, make sure that’he is not’don't act’a break in the’uterus », Observes the specialist.
-After a vaginal delivery in a patient with a history of caesarean section if abnormalities in the fetal heartbeat have been noted, as there is a greater risk of uterine tearing. It is always done during a cesarean section.
-During a premature delivery, the doctor may – sometimes – have to perform a uterine revision to check whether or not there is a uterine malformation explaining this premature delivery.
Concretely, how does a uterine revision go?
If the doctor or midwife finds that it is necessary to perform a uterine revision, he / she will warn the patient first in order to explain what will happen and how she will feel. Sometimes the dad will be asked to leave the room because the gesture can be impressive. " It consists in gently introducing the hand, and sometimes the wrist or the’forearm in the vagina then the uterus to check the’entire uterine cavity, and s’ensure its emptiness », Summarizes the doctor. " In case of doubts or bleeding, uterine revision is the first thing to do, and it is sometimes very urgent », Says Professor Huissoud.
Uterine revision, a painful gesture?
Uterine revision is always unpleasant and often painful. But the medical team made sure to relieve the patient with epidural anesthesia, or spinal anesthesia which has the advantage of being faster. If the patient is not equipped, she can be put under general anesthesia. " The practitioner will take the opportunity to check that’he doesn’there is no’other lesions in the vagina, cervix’uterus and suture any tears », Continues the doctor.
What postpartum monitoring?
According to the initial indication for management, the mother is kept under observation to verify the absence of bleeding and the correct retraction of the uterus. Sometimes antibiotics may be prescribed to prevent the risk of infection. If all is well, the patient can return to her room a few hours later.