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.

Indications

Retained Placenta

Placenta not delivered within 30 minutes

Postpartum Hemorrhage

Ongoing bleeding

Adherent Placenta

Partial separation

Failed Medical Management

Oxytocin unsuccessful

Maternal Instability

Hemodynamic compromise

Contraindications

Absolute Contraindications

Patient refusal
Suspected placenta accreta

Relative Contraindications

Coagulopathy
Severe infection

📋 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.