Manual removal of the placenta is a procedure for extracting a retained placenta after childbirth when it has not been expelled within 30 minutes. The process involves positioning the patient, utilizing antiseptic techniques, and carefully detaching the placenta using a specific hand technique while supporting the uterus. Post-procedure care includes administering oxytocin, massaging the fundus, and ensuring examination and repair of any tears or episiotomies.

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

7. • 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.

9. • 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

11. • 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

13. 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of the hand that is being withdrawn.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

14. 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.