SUMMARY OF THE JOURNAL:

This study entitled “The Windmill technique avoids manual removal of the retained
placenta- A new solution for an old problem” is made to solve the unsolved problem from a
research article entitled “Manual Removal of the Placenta after Vaginal Delivery: An unsolved
problem in Obstetrics”. This study has the review of related literature from various articles
wherein they give us information where maternal deaths reported as high as 10%. From that
percentage, the incidence of retained placenta ranges from 0.1% to 3.3%. Retained Placenta is
defined as non-delivery of the placenta after 30 minutes following birth. Traditionally, the
MROP (Manual Removal of Retained Placenta) is used to deliver the placenta however MROP
causes high risk of different complications such as hemorrhage, postpartum infection, uterine
perforation and uterine inversion. Furthermore, before MROP will be employed, a lot of
strategies such as use of uterotonics, umbilical oxytocin injection, nitroglycerine (relaxant),
controlled cord traction, uterine massage and acupuncture were used but none of these have
proven their benefits. Therefore, the Charité University Hospital in Berlin, developed a new
technique named Windmill technique to deliver the placenta, and it also had proposed
different benefit.

This study executed a 3- year retrospective, case-controlled and observational study at

Charité University Hospital in Berlin. They have their inclusion criteria and exclusion criteria
from this study. For the inclusion criteria they included patients with retained placenta for 30
minutes after vaginal delivery, they also included patients who undergone different
interventions but failed. The gathered participants were gathered and consented to do the
windmill technique. However, patients with suspected placenta implantation problems and
with less than 37 weeks age of gestation were excluded from this study

The results showed 2 outcomes. For the primary outcome, the new technique gained
86% wherein patients with retained placenta avoided to perform MROP. For the secondary
outcome, using the new method, 1.) postoperative fall in hgb was less compared to MROP, 2.)
duration was only 7 minutes for the new technique compared to MROP which, 3.) the new
technique, it only utilized 57% of epidural; no extra pain relief, compared to MROP that
utilized general anesthetic, spinal and epidural. 4.) for the windmill technique, 14% of their
patients only received prophylactic antibiotics while for the MOP, all their patient received
antibiotic prophylaxis.
 Therefore this study concluded that the new technique which is the Windmill
technique is a simple, safe, effective and easy to use and therefore, reduces the usage of MROP.
It also reduces postpartum blood loss, reduces delay in the placenta delivery and reduces
anesthesia intervention and antibiotic usage.

INSIGHTS:

1. PATIENT’S CARE
For my future patients, I would recommend this technique because it will help
them better. However, the decision will depend on the patient if she will use the
traditional method or the windmill method. But before recommending this
method, I will explain and demonstrate on how this method will work rather
than the other method. I will show an evidence based practice or a research
supporting this technique.

2. AREA OF ROTATION/LOCAL SETTING

This study can help understand better methods of removing the placenta. This
method should be introduced not only in the hospital but also in the community
where other people don’t have access to internet.

3. NURSING EDUCATION, PRACTICE, AND RESEARCH

This study will enhance the knowledge of another student about the delivery of
placenta, that a new technique can be used. It is also safe and simple to use.
Rather than using the traditional method which can complicate the patient’s
condition. This study can be an option. An implementation of this technique can
minimize the complicated outcomes of the traditional method.

4. INSIGHT FROM JOURNAL

After reading and researching about this journal, I gained knowledge about
what is the traditional method used to deliver the placenta here in the
Philippines and in the other countries. This journal introduced another method
to remove the placenta which is the Windmill technique. This study proved that
this technique will benefit the patients. This could serve as an evidence based
practice.
REFERENCES:

1. Hinkson, L., Suermann, M. A., Henrich, W., & Hinkson, S. (2017). The Windmill
technique avoids manual removal of the retained placenta—A new solution for an old
problem. European Journal Of Obstetrics & Gynecology & Reproductive Biology, 2156-
11. doi:10.1016/j.ejogrb.2017.05.028

2. Urner, F., Zimmermann, R., & Krafft, A. (2014). Manual Removal of the Placenta after
Vaginal Delivery: An Unsolved Problem in Obstetrics. Journal Of Pregnancy, 1-5.
doi:10.1155/2014/274651