Overview
Manual Removal of Placenta is an obstetric procedure performed when the placenta fails to deliver spontaneously after childbirth. It is an emergency intervention to prevent postpartum hemorrhage.
Manual removal is crucial for preventing severe postpartum hemorrhage and infection. It requires prompt action and skilled technique.
Learn more in our comprehensive RxDx OBG Course
Indications
Placenta not delivered within 30 minutes
Ongoing bleeding
Partial separation
Oxytocin unsuccessful
Hemodynamic compromise
Contraindications
Absolute Contraindications
Relative Contraindications
📋 Equipment Checklist
Check off items as you gather them:
Pre-procedure Preparation
Preparation includes patient consent (if possible), anesthesia, sterile technique, and resuscitation equipment.Step-by-Step Procedure
Step 1: Patient Preparation
Explain procedure, obtain consent if possible, position patient.
⚠️ Common Mistakes to Avoid:
- Inadequate consent
- Poor positioning
💡 Pro Tip:
Position patient in lithotomy position.
Step 2: Anesthesia
Administer anesthesia as appropriate.
⚠️ Common Mistakes to Avoid:
- Inadequate anesthesia
- Wrong type
💡 Pro Tip:
Use general or regional anesthesia.
Step 3: Aseptic Technique
Perform hand hygiene and wear sterile gloves.
⚠️ Common Mistakes to Avoid:
- Poor asepsis
- Contamination
💡 Pro Tip:
Strict aseptic technique.
Step 4: Manual Removal
Insert hand into uterus and gently separate placenta.
⚠️ Common Mistakes to Avoid:
- Rough technique
- Incomplete removal
💡 Pro Tip:
Use gentle, sweeping motion.
Step 5: Uterine Massage
Massage uterus to promote contraction.
⚠️ Common Mistakes to Avoid:
- Inadequate massage
- Continued bleeding
💡 Pro Tip:
Massage until firm.
Step 6: Hemostasis
Ensure adequate hemostasis.
⚠️ Common Mistakes to Avoid:
- Bleeding
- Hematoma
💡 Pro Tip:
Monitor for ongoing bleeding.
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Post-procedure Care
Post-procedure care involves monitoring for bleeding, infection, and uterine involution.Complications & Management
Complication | Incidence | Signs | Management | Prevention |
---|---|---|---|---|
Hemorrhage | 5-10% | Excessive bleeding | Resuscitation, transfusion | Prompt technique |
Infection | 3-8% | Fever, foul discharge | Antibiotics | Sterile technique |
Uterine perforation | 1-2% | Abdominal pain, bleeding | Laparoscopy, observation | Gentle technique |
Retained fragments | 2-5% | Continued bleeding | Repeat removal | Thorough inspection |
Clinical Pearls
Use gentle, sweeping motion for removal.
Strict aseptic technique is essential.
Massage uterus until firm.
Monitor for ongoing bleeding.
Document all findings and actions.
Provide post-procedure counseling.
Be prepared for emergency management.