Mannual removal of placenta

The placenta is said to be retained when it is not expelled from the uterus even 30 minutes after the delivery of the baby
Manual placenta removal is a procedure to remove a retained placenta from the uterus after childbirth.
Mannual removal of placenta is done under GA.
Patient placed in lithotomy position
Bladder is catheterized

1. MANNUAL REMOVAL OF PLACENTA PRANATI PATRA

2. RETAINED PLACENTA The placenta is said to be retained when it is not expelled from the uterus even 30 minutes after the delivery of the baby

3. DEFINITION OF MANNUAL REMOVAL OF PLACENTA Manual placenta removal is a procedure to remove a retained placenta from the uterus after childbirth.

4. STEPS- I Mannual removal of placenta is done under GA. Patient placed in lithotomy position Bladder is catheterized

5. Use antiseptic hand rub or wash hands and forearms Put high-level disinfected or sterile surgical gloves on both hands. Hold the umbilical cord with a clamp. STEPS-II

6. 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.

7. 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 STEPS-III

8. 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

9. 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 Continue to provide counter-traction to the fundus by pushing it in the opposite direction of the hand that is being withdrawn. STEPS-IV

10. POST PROCEDURE CARE 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. If there 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.