Gabastou Method

GABASTOU METHOD (Gabastou, incorrectly called Gabaston earlier), proposed in 1914 (a hundred years ago it was used by Mojon; so-called "Mojon injections") for the artificial separation of a retained placenta by introducing through the umbilical vein a sterile, or disinfecting, antiseptic liquid (more often sterilized physiological saline solution or simple sterile water). Gabastou calls his method "hydrolytic." Injections are made with a large (150.0-200.0) glass or metal syringe, which is connected to the umbilical vein by a special cannula (see figure) or with the help of a simple tip for an enema. They inject carefully, under low pressure.

Glass tip for the Gabastou method.

up to 500 cubic centimeters of liquid (in isolated cases, up to 2 liters were injected). For a better effect, some introduce the liquid in a cold or warmed (up to 40-50°) form. Thanks to the injection, the placental vessels are filled with liquid, the volume of the placenta increases, it becomes heavier, the liquid begins to flow out from the vessels of the villi, whereby a bloody, watery liquid is also discharged from the vagina. After the injection, it is sufficient to use light massage or the Credé method (better in combination with pituitary preparations) to obtain the desired effect; but often, even without the named manipulations, the placenta easily separates from the uterine walls and is expelled outward. The mechanism of action of the Gabastou-Mojon method is explained by some as an increase in the weight and volume of the placenta, as well as the introduction of liquid between it and the uterine wall (retroplacental hydroma), which supposedly leads to an acceleration of the process of separation of the placenta; others (and with more right) see the reason for the favorable effect of the Gabastou-Mojon method in the renewal and strengthening of uterine contractions due to reflex irritation caused by the liquid introduced through the placental vessels. Some, finally (though without sufficient grounds), attribute a hemostatic effect to the Gabastou-Mojon method (during large hemorrhages, thanks to the separation of the placenta over a large area, the liquid accumulating between the uterine wall and the placenta supposedly plays the role of a tampon). The Gabastou-Mojon method has found many imitators. In order to avoid dangerous manual separation of the placenta, it is willingly used for simple, without hemorrhage, retention of the placenta (retentio placentae), for incarceration of the latter (incarceratio placentae); some use this method in the third stage of labor in cases of placenta praevia. Clinical observations show that where the Gabastou-Mojon method is systematically used, manual separation of the placenta is indeed observed significantly less often (by 20%, according to Winter). In infected cases, the Gabastou-Mojon method should not be used. Also, it should not be used in cases of threatening hemorrhages, when manual separation can give a more certain and reliable effect. In cases of true placenta accreta (placenta accreta), the Gabastou-Mojon method, naturally, also does not help. But even in those cases where this method is indicated, it does not always give a positive result (according to Winter and Kositz, failures occur in more than a third of cases). Among the complications noted in the literature when using the Gabastou-Mojon method, one should point out the possibility of detachment of villi and their transport into the mother's bloodstream, as well as the possibility of air embolism. Some noted phenomena of shock with the Gabastou-Mojon method, the cause of which, in all probability, should be sought in the same embolism. The Gabastou-Mojon method should be used in a hospital setting.