Manual removal of the placenta
Indication
Retained placenta after vaginal delivery, where the placenta failed to separate spontaneously or by controlled cord traction in the third stage of labour. Under such circumstances, manual removal of the placenta will be necessary.
Procedure
The procedure is performed under regional or general anaesthesia in the operating theatre. Prophylactic antibiotics should be given. The operator inserts his/her hand through the dilated cervix into the uterine cavity, identifies the placenta by following the cord, and separates the placenta by shearing movements of the hand between the placenta and the uterus while steadying the uterus abdominally by the other hand. Once the whole placenta is detached from the uterine wall it is removed. The chorionic and the amniotic surfaces of the placenta are checked for completeness. The cavity is checked for any retained tissue at the end of the procedure. The uterus should be massaged to secure a contraction and contraction and retraction is sustained by a Syntocinon infusion to reduce blood loss.
Risks and complications
Possible complications include postpartum haemorrhage, intrauterine infection, and perforation of the uterus.