Manual removal of retained placenta is performed when the placenta fails to deliver within 30 minutes of childbirth. The procedure involves preparing equipment and medications, administering anesthesia and antibiotics, and manually inserting the hand into the uterus to detach and remove the placenta while supporting the uterine fundus. The provider must ensure the placenta is fully removed and the uterus remains contracted after delivery, and closely monitor the woman for complications.

1. Mrs. U SREEVIDYA Msc.
NURSING,
Associate Professor,
Apollo college of nursing,
CHITTOOR

2. Failure of placental
delivery within 30 minutes
after delivery of the fetus.

3. Manual placenta removal is a
procedure to remove a retained
placenta from the uterus after childbirth

4. 
• Take blood for grouping and cross match and send
for hemoglobin if it has not been done
Tell the woman (and her support person) what is
going to be done, listen to her and respond
attentively to her questions and concerns.
• Provide continual emotional support and
reassurance, as feasible.

5. Prepare the necessary equipment
• Antiseptic solution
• Sterile gloves
• Blood and subtitutes
• Anasthesia and analgesics
• Ergometrine and oxytocin
Antibiotics

6. 

Give anesthesia (IV pethidine (25-50mg) and
diazepam (10 mg), or ketamine
Give a single dose of prophylactic antibiotics: Ampicillin
2 g IV PLUS metronidazole 500 mg IV, OR


Cefazolin 1 g IV PLUS metronidazole 500 mg IV
Put on personal protective equipment.

7. Procedure is done under GA
If not available under deep sedation
Patient placed in lithotomy position
Bladder is catheterized

8.  Use antiseptic hand rub or wash hands and forearms.
 Put high-level disinfected or sterile surgical gloves on
both hands. (Note: elbow-length gloves should be
used, if available.)
 Hold the umbilical cord with a clamp
 Pull the cord gently until it is parallel to the floor

9. 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.

10. Introducing one
hand into the
vagina along cord

11. 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


12. Supporting the fundus
while detaching the
placenta

13. 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

15.  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.

16.  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.

17.  Examine the placenta for
completeness
 Check for contracted uterus

18.  Immerse both gloved hands in 0.5%
chlorine solution. Remove gloves by
turning them inside out.
If disposing of gloves, place them in a
leak proof container or plastic bag.
 If reusing surgical gloves, submerge
them in 0.5% chlorine solution for 10
minutes for decontamination

19.  Use antiseptic hand rub or wash hands thoroughly
with soap and water and dry with a clean, dry
cloth or air dry.
 Monitor vaginal bleeding and take the woman’s
vital signs:
Every 15 minutes for 1 hour
Then every 30 minutes for 2 hours
 Make sure that the uterus is firmly contracted.
 Record procedure and findings on woman’s record.

20.  Observe the woman closely until the effect of IV
sedation has worn off.
 Monitor the vital signs (pulse, blood pressure,
respiration) every 30 minutes for the next 6 hours or
until stable.
 Palpate the uterine fundus to ensure that the uterus
remains contracted.
 Check for excessive lochia.
 Continue infusion of IV fluids.
 Transfuse as necessary.

21.  Shock
 Postpartum haemorrhage
 Puerperal Sepsis
 Subinvolution
 Inversion
 Hysterectomy
 Embolism
 Thrombhophelebitis