Mrs. U SREEVIDYA Msc.

NURSING,
Associate Professor,
Apollo college of nursing,
CHITTOOR
 Failure of placental
delivery within 30 minutes
after delivery of the fetus.
 Manual placenta removal is a
procedure to remov a retained
placenta from the uterus
e after
childbirth


• Take blood for grouping and cross match and send

for hemoglobin if it has not been done
Tell the woman (and her support person) what is
going to be done, listen to her and
attentively to her questions and concerns. respond

• Provide continual emotional support

and reassurance, as feasible.
Prepare the necessary equipment

• Antiseptic solution
• Sterile gloves
• Blood and subtitutes
• Anasthesia and analgesics
• Ergometrine oxytocin
and Antibiotics
□ Give anesthesia (IV pethidine (25-50mg)
and diazepam (10 mg), or ketamine
 Give a single dose of prophylactic antibiotics:
Ampicillin 2 g IV PLUS metronidazole 500 mg IV,OR
□Cefazolin 1 g IV PLUS metronidazole 500 mg IV
 Put on personal protective equipment.
 Procedure is done under GA
 If not available under deep sedation

 Patient placed in lithotomy position

 Bladder is catheterized
Use antiseptic hand rub or wash hands and forearms.
Put high-level disinfected or sterile surgical gloves on
both hands. (Note: elbow-length gloves should be
used, if available.)
Hold the umbilical cord with a clamp
Pull the cord gently until it is parallel to the floor
 Place the fingers of one hand into the vagina
in the shape of cone by drawing the fingers and the
thumb together and into the uterine cavity, following
the direction of the cord until the placenta is located.
Introducing
one hand
into
vagina the cord
along
 When the placenta has been located, let go
of the cord and move that hand onto the abdomen to
support the fundus abdominally and to provide counter-
traction to prevent uterine inversion .
Move the fingers of the hand in the uterus
laterally
🞂
until the edge of the placenta is located. Supporting
the
fundus while detaching the placenta
Supporting the fundus
while detaching the
placenta
 Keeping the fingers tightly together, ease the edge
of the hand gently between the placenta and the uterine
wall, with the palm facing the placenta.
Gradually move the hand back and forth in a
smooth lateral motion until the whole placenta is separated
from the uterine wall withdrawing the hand from the uterus
When the placenta is completely separated
Palpate the inside of the uterine cavity to ensure that all
placental tissue has been removed.
Slowly withdraw the hand from the uterus bringing the
placenta with it.
Continue to provide counter-traction to the fundus by
pushing it in the opposite direction of the hand that is
being withdrawn.
Give oxytocin 20 units in 1 L IV fluid (normal saline
or Ringer’s lactate) at 60 drops/minute.
Massage the fundus to encourage atonic
uterine contraction.
Ifthere is continued heavy bleeding- Give
ergometrine
0.2 mg IM or give prostaglandins.
Examine the uterine surface of the placenta to ensure that
it is complete. Examine the woman carefully and repair
any tears to the cervix or vagina, or repair episiotomy.
Examine the placenta for
completeness
Check for contracted
uterus
□ Immerse both gloved hands in 0.5%
chlorine solution. Remove gloves by
turning them inside out.
 If disposing of gloves, place them in a
leak proof container or plastic bag.
□ Ifreusing surgical gloves, submerge
them in 0.5% chlorine solution for 10
minutes for decontamination
□ Use antiseptic hand rub or wash hands thoroughly
with soap and water and dry with a clean, dry
cloth or air dry.
□ Monitor vaginal bleeding and take the woman’s
vital signs:
 Every 15 minutes for 1 hour
 Then every 30 minutes for 2 hours
□ Make sure that the uterus is firmly contracted.
□ Record procedure and findings on woman’s record.
□ Observethe woman closely until the effect of
sedation has worn IV
□ off.
Monitor the vital signs (pulse, blood
respiration) every 30 minutes for the next 6 hours or
pressure,
until stable.
□ Palpate the uterine fundus to ensure that the
uterus remains contracted.
□ Check for excessive lochia.
□ Continue infusion of IV fluids.
□ Transfuse as necessary.
Shock
Postpartum
haemorrhage
Puerperal Sepsis
Subinvolution
Inversion
Hysterectomy
Embolism
Thrombhophelebitis