Efficacy of Secale cor in retained and incomplete expulsion of Placenta

Dr.Shahnaz M Madiwale
Interns: Vishal rudra ,Rehan iranpur, Alisha nadaf

Efficacy of Secale cor 30 in management of retained and incomplete expulsion of Placenta in age group 25-40 years

ABSTRACT:
 Retained placenta represents a cause of maternal morbidity and mortality affecting 0.5–3% of all vaginal deliveries. The unpredictability of this condition makes difficult to develop predictive and preventive strategies to apply in clinical practice. This analysis collected and analyzed all known risk factors related to this obstetric complication.

Methods
A systematic literature review for all original research articles published between 1990 and 2020 was performed. Observational studies about retained placenta risk factors published in English language were considered eligible. Conference abstracts, untraceable articles and studies focused on morbidly adherent placenta were excluded. The included articles were screened to identify study design, number of enrolled patients and retained placenta risk factors investigated. All stages of the revision followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement.

Results
Thirty-five studies met the inclusion criteria. The reported retained placenta prevalence ranged from 0.5 to 4.8%. Maternal age, previous cesarean sections, previous dilation and curettage, previous retained placenta, labor induction, resulted as the most recurrent, independent risk factors for retained placenta. Previous estro-progestins therapy, morphological placental features (weight, shape, insertion of umbilical cord, implantation site), endometriosis, Assisted Reproductive Technologies, Apgar score are fascinating new proposal risk factors.

Conclusions
Old and new data are not enough robust to draw firm conclusions. Prospective and well-designed studies, based on a well agreed internationally retained placenta definition, are needed in order to clarify this potential dramatic and life-threatening condition.       

OBJECTIVES OF STUDY:

1.To study the effectiveness of secalecor in the management of retained placenta.

METHODOLOGY:

            Type Of Research: AN INTERVENTIONAL STUDY..

INTRODUCTION: Retained placenta after vaginal delivery, which occurs in around 1–3% of deliveries, is a relatively common cause of obstetrical morbidity. This is typically diagnosed when the placenta fails to spontaneously separate during the third stage of labour when a patient experiences excessive bleeding in absence of placenta separation or if there is confirmation of placenta tissue remaining after the majority of the placenta delivers spontaneously.^[2]

Placenta that fail to spontaneously separate can be a cause of significant surgical and hemorrhagic morbidity.^[3-4]

Untreated, retained placenta is considered the second leading cause of postpartum haemorrhage (PPH).^[4-5]

DEFINITION: The final stage of labour occurs when the placenta is expelled from the mother’s uterus. For many women, this process happens on its own after the baby has come through the birth canal. However, for some, this process doesn’t happen automatically, resulting in a phenomenon called retained placenta

ICD CLASSIFICATION: ICD 10 (073.0)

EPIDEMILOGY:

PREVALENCE RATE:

Retained placenta affects 0.5 – 3% of all vaginal deliveries and is considered one of the major causes of primary and secondary postpartum haemorrhage.

ETIOLOGY: At present, only a few numbers of risk factors for RP have been recognized with certainty. A previous retained placenta, older maternal age and prolonged use of oxytocin have been demonstrated to be correlated to RP. But instead, conflicting results have been reported about the role of parity, smoking, gestational diabetes as well as Assisted Reproductive Technologies (ART)

RISK FACTORS FOR RETAINED PLACENTA:

Factors that increase the risk of retained placenta;

• Smoking
• Previous uterine surgery
• Uterine pathology 

CLASSIFICATION:

• Placenta Adherens
• Trapped Placenta
• Placenta Accreta

Three Types of Retained Placenta

1. Placenta Adherens: occurs when the contractions of the womb are not robust enough to completely expel the placenta. This results in the placenta remaining loosely attached to the wall of the uterus. This is the most common type of retained placenta.
2. Trapped Placenta: is when the placenta successfully detaches from the uterine wall but fails to be expelled from the woman’s body it is considered a trapped placenta. This usually happens as a result of the cervix closing before the placenta has been expelled. The Trapped Placenta is left inside the uterus.
3. Placenta Accreta: is when the placenta attaches to the muscular walls of the uterus instead of the lining of the uterine walls. Delivery becomes more difficult and often results in severe bleeding. Blood transfusions and even a hysterectomy may be required.

SIGNS AND SYMPTOMS:

What Causes a Retained Placenta?

• Placenta Percreta occurs when the placenta grows all the way through the wall of the womb.
• Uterine Atony occurs when a woman’s contractions stop or are not strong enough to expel the placenta from her womb.
• Adherent Placenta takes place when all or part of the placenta is stuck to the wall of the woman’s womb. In rare situations, this happens because the placenta has become deeply embedded within the womb.
• Placenta Accreta takes place when the placenta has become deeply embedded in the womb, possibly due to a previous cesarean section scar.
• A Trapped Placenta results when the placenta detaches from the uterus but is not delivered. Instead, it becomes trapped behind a closed cervix or a cervix that has partially closed.

A midwife can help prevent a retained placenta on rare occasions by gently pulling on the umbilical cord. However, the cord may break if the placenta has not completely separated from the uterine walls or if the cord is thin. If this happens, delivery of the placenta can take place by using a contraction to push it out.

CLINICAL PRESENTATION:

The most obvious sign of a retained placenta is when the placenta fails to be completely removed from the womb an hour after the baby’s delivery. Other symptoms may include:

• fever
• a foul-smelling discharge from the vaginal area
• large pieces of tissue coming from the placenta
• heavy bleeding pain that doesn’t stop.

CLINICAL DIAGNOSIS:

-Placenta Adherens

-Trapped Placenta

-Placenta Accreta

COMPLICATIONS:Retained placenta can be serious. In rare cases, it can lead to life-threatening infection or blood loss (postpartum hemorrhage).

While there is usually some normal blood loss with birth, blood loss associated with retained placenta can be very severe. This is because the area in the uterus where the placenta is still attached can continue to bleed.

Postpartum hemorrhage can be divided into:

• primary postpartum hemorrhage – this happens within the first 24 hours after delivery
• secondary postpartum hemorrhage – this happens in the days and weeks following birth (between 24 hrs and 6 weeks after birth)

Diagnosing and managing retained placenta early helps prevent complications such as severe blood loss and infection.^[1]

MANAGEMENT:

Secale Cornutum:

Introduction

Common Name: Ergotorrye , Spurredrye

Ergot is a fungus, from family Clavicepitaceae, botanical name being Claviceps purpura. Secale Cor is made from the plant Rye infected by Claviceps. Rye is a grass that produced Rye was first cultivated rather late in human history, perhaps as recently as 2000 to 3000 years ago. It is still grown extensively in northern Europe and Asia. It lacks the proteins that make wheat suitable for living, and rye bread is denser and usually darker than the wheat bread, hence called Black Bread.(24)

Ergot appears as black grain size fungal structures. In late spring , these ergots germinate and form tiny spore producing mushroom like structures. Infectious spores are carried by wind currents to the host during the flowering stage. Infection of the cereal flowers may produce a secondary phase called Honeydew. Honeydew is a shiny sticky liquid that oozes from infected flowers and contains large numbers of ergot spores. The spores spread to adjacent flowers and heads by insects and rain splash particularly to the open flowers of rye. Ergot that germinate in June can infect early flowering weed grasses, which produce honeydew when cereals are flowering.

It gives out a sickening heavy smell. Its colour is externally purplish black. Internally it is pinkish white. It has a nauseous and slightly acrid taste.

After an overdose of ergot or medications derived from ergot or from eating flour milled from ergot infected rye, humans and livestock may develop ergotism, a condition sometimes called as St. Anthony’s Fire. The symptoms include Convulsions, Miscarriages and Dry Gangrene and may be Death. It contains the crystalline alkaloid Ergotamine, Ergotinine and the amorphous alkaloid Ergotoxine.(24)

Female.–Menstrual colic, with coldness and intolerance of heat. Passive haemorrhages in feeble, cachectic women. Burning pains in uterus. Brownish, offensive leucorrhoea. Menses irregular, copious, dark; continuous oozing of watery blood until next period.During labor no expulsive action, though everything is relaxed.(25)

DISCUSSION:
The final stage of labour occurs when the placenta is expelled from the mother’s uterus. For many women, this process happens on its own after the baby has come through the birth canal. However, for some, this process doesn’t happen automatically, resulting in a phenomenon called retained placenta

Retained placenta after vaginal delivery, which occurs in around 1–3% of deliveries, is a relatively common cause of obstetrical morbidity. This is typically diagnosed when the placenta fails to spontaneously separate during the third stage of labour when a patient experiences excessive bleeding in absence of placenta separation or if there is confirmation of placenta tissue remaining after the majority of the placenta delivers spontaneously.

In my study I have made a moderate attempt to study the effects of Homoeopathic remedy Secale Cornutum in the management of Retained placenta in a systematic and scientific manner. Out of all 30 patients the age incidence was between 25-40 yrs.It was observed that out of 30 subjects, 73% showed improvement after Secale Cornutum was given whereas 27% showed no improvement after Secale Cornutum was given.

This study was successful one in terms of fulfilling the interventional set for the study. This was the modest effort on my part to find the role of Homoeopathic remedy SECALE CORNUTUM in the management of Retained Placenta.

OBSERVATION AND RESULT:

 

CONCLUSION:
It was observed that out of 30 subjects, 73% showed improvement after SecaleCornutum was given whereas 27% showed no improvement after SecaleCornutum was given.

Therefore,we conclude that the retention of placenta with symptoms of heavy bleeding after labour and oozing of watery blood continuously are well treated by SecaleCornutum and it shows good results.

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Dr.Shahnaz M Madiwale  MD (Hom)
Associate Professor
Department Of OBG
A.M.Shaikh Homoeopathic Medical College Belgavi

Interns: Vishal rudra ,Rehan iranpur, Alisha nadaf