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Minor & bedside proceduresFree in the app

Manual removal of placenta

Retained placenta or PPH with placenta in situ.

Source: NICE NG235
Retained placenta: not delivered 30 min after active, or 60 min after physiological third stage.

Steps

  1. IV access, FBC & cross-match; regional or GA; catheterise.
  2. Single dose IV prophylactic antibiotic.
  3. Abdominal hand holds the fundus; other hand follows cord in, coned.
  4. Find placental edge; shear off with the side of the hand.
  5. Remove whole; explore cavity until empty.
  6. Oxytocin infusion; check placenta complete.
Risks: PPH, infection, uterine inversion, morbidly adherent placenta.
A summary for trained clinicians. Always check the full guideline, the patient in front of you and your hospital's protocol. Spotted an error? Tell us.