Acupuncture for retained placenta: a retrospective case series

The Windmill technique avoids manual removal of the retained placenta-A new solution for an old problem

OBJECTIVE

The primary objective is to assess the reduction in manual removal of placenta with the Windmill technique of placenta delivery in patients with retained placenta.

DESIGN

The Windmill technique involves the application of continuous 360° umbilical cord traction and rotation in such a manner as to be perpendicular to the direction of the birth canal at the level of the introitus. This rotation through 360° is repeated slowly with movement akin to the motion of the blades of a windmill. We performed a 3-year retrospective case-control study at the Charité University Hospital in Berlin. Patients with a retained placenta more than 30min following failed traditional interventions were consented and offered the Windmill technique of placenta delivery. Study cases were compared to controls where an operative manual removal of placenta was performed. Patients with suspected placenta implantation problems, uterine atony, bleeding due to vaginal tract injury and coagulation disturbances were excluded.

RESULTS

Over the study period 14 patients were recruited to the study arm and 17 patients were in the control group. With the Windmill technique for retained placenta, 86% (12/14, p<0.001) of patients avoided invasive operative manual removal of the placenta in theatre. There was a statistically significant reduction in mean blood loss (429ml vs 724ml, p=0.001) and mean postoperative fall in hemoglobin values (1.3g/dl vs 2.5g/dl, p=0.04). There was a reduction in the time to delivery of the placenta, antibiotic prophylaxis and use of general anesthesia.

CONCLUSION

The Windmill technique for the delivery of the retained placenta is a simple, safe, effective and easy to teach technique that reduces invasive operative manual removal of the placenta, postpartum blood loss and delay in the placenta delivery. This innovative technique can also be a lifesaving intervention especially in areas with limited or no access to operative facilities.

Electroacupuncture relieves labour pain and influences the spinal dynorphin/κ-opioid receptor system in rats

BACKGROUND

The dynorphin (DYN)/κ-opioid receptor (KOR) system plays a key role in the control of labour pain. Our previous clinical study reported that electroacupuncture (EA) provided intrapartum analgesia, but the underlying mechanisms of action have not been fully elucidated.

AIMS

To observe the effect of EA on labour pain and to explore the underlying mechanisms of action in a rat model.

METHODS

Copulation-confirmed pregnant rats (n=120) were given castor oil to induce labour. Rats remained untreated (control group, n=20) or received either meperidine (an opioid that is commonly used to treat labour pain, n=20) or EA at SP6, LI4, SP6+LI4 or SP10 (four groups, n=20 each). Labour pain was evaluated by the warm water tail-flick test. Serum DYN values were measured by ELISA. Protein and mRNA expression of prodynorphin (PDYN, the precursor protein of DYN) and KOR were analysed by Western blotting and real-time PCR, respectively.

RESULTS

EA treatment at all acupuncture point combinations studied significantly relieved labour pain and increased serum DYN concentrations, to a degree similar to that achieved with meperidine. EA notably enhanced protein expression of KOR and PDYN and mRNA expression in the lumbar spinal cord but not in the cerebral cortex. The size of effect varied by EA group in the order: SP6>LI4>SP6+LI4>SP10 for all parameters measured, indicating differential effects relating to acupuncture point selection/combination.

CONCLUSIONS

The present study indicates that EA relieves labour pain, at least in part, by regulation of the spinal DYN/KOR system in a rat model.

Third Stage of Labor and Acupuncture

Background: Acupuncture use in obstetrics has been increasing in Western medicine, especially to alleviate complications of pregnancy, the most important cause of maternal mortality worldwide. One quarter of maternal deaths are caused by complications in the third stage of labor, an interval between complete delivery of the baby and the complete expulsion of the placenta. Methods: This review analyzes the increased acupuncture use for pregnancy complications as a potential method of reducting maternal mortality during the third stage of labor. This overview focuses on acupuncture points and techniques to manage the third stage of labor and help patients with retained placentas. Passive (or expectant) management of the third stage of labor is occasionally associated with massive obstetric hemorrhage, a major cause of maternal morbidity and mortality, especially in low-income countries. Conclusions: Active management of the third stage of labor has been shown to reduce the risk of postpartum hemorrhage. Use of acupuncture in the first and second stages of labor could lead to a faster separation of the placenta in the third stage of labor. The possible effects of acupuncture in cases of retained placentas may have significant implications for possible complications and final outcomes of labor. Further studies are needed for more conclusive results.