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Vasa Praevia

The document discusses manual removal of placenta, which is a procedure to remove a retained placenta from the uterus after childbirth. It describes the steps of the procedure, which involves introducing the hand into the uterus following the umbilical cord to locate and detach the placenta by making slicing movements with the hand while supporting the uterine wall and fundus.

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Ashwini
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125 views

Vasa Praevia

The document discusses manual removal of placenta, which is a procedure to remove a retained placenta from the uterus after childbirth. It describes the steps of the procedure, which involves introducing the hand into the uterus following the umbilical cord to locate and detach the placenta by making slicing movements with the hand while supporting the uterine wall and fundus.

Uploaded by

Ashwini
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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VASA PRAEVIA

ASHWINI M R
INTRODUCTION
Conti…
ETIOLOGY
FIGURE
CLINICAL FEATURES
DIAGNOSIS
CONTI…
MANAGEMENT
MANAGEMENT
Amniotic fluid embolism
Risk factors
Clinical features
Diagnosis
Management
Management
Management
MANUAL REMOVAL OF PLACENTA
ashwini M R
Retained placenta

Failure of placental delivery within 30 minutes


after delivery of the fetus.
MANUAL REMOVAL OF PLACENTA
Manual placenta removal is a procedure to remove
a retained placenta from the uterus after childbirth
Procedure
Step-1
❑MRP is done under GA
❑If not available under deep sedation
❑Patient placed in lithotomy position
❑Bladder is catheterized
Step -2
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


Conti….
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.
Step-3
• 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
Introduction of the hand into the uterus in a cone shaped
manner following the taut umbilical cord
The placenta is separated by
(A) keeping the back of the hand in contact with the uterine wall
(B) with slicing movements of the hand
Conti…
• 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
Step-4
• 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.
Step -4
• 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.
Step-5
•Examine the placenta for completeness
• Check for contracted uterus
Complication
• Shock
• Postpartum haemorrhage
• Puerperal Sepsis
• Subinvolution
• Inversion
• Hysterectomy
• Embolism
• Thrombhophelebitis

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