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Manual Removal of Placenta

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38 views12 pages

Manual Removal of Placenta

Uploaded by

sillentboyaaaa
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Manual removal of

placenta
Dr Uong Sokhan
OBJECTIVES
• 1. Identify the indication of MROP
• 2. Describe the procedure of MROP
• 3 Identify the problem during MROP and
its management
I.INDICATION :
- Total retained placenta
- Postpartum hemorrhage
II.PREPARATION:
- Prepare the necessary equipement
- Tell the women and her support
person what is going to be done.
– Have the women empty her bladder or insert
the cather, if necessary.
– Give premedication is necessary:
• Pethedine and Diazepam IV slowly
– Give a single dose of prophylactic antibiotic
• Ampicilline 2g IV + Metronidazol 500mg IV
– Put on personal protective equipment
PROCEDURE:
1. Wash hand thoroughly and dry
2. Put sterile surgical gloves on both hands (Long
gloves should be use)
3. Hold the umbilical cord with a clamp. Pull the
cord gently until it is parallel to the floor
4. Introducing one hand into the vagina along
cord and into the uterine cavity until the
placenta is located.
5. Let go of the cord and move that hand on to the
abdomen to support the fundus abdominally
and to provide counter traction during removal.
6. Move the fingers of the hand in the uterus
laterally until the edge of the placenta is located.
7. Keeping the fingers tightly together, and using
the edge of the hand to gradully make a space
between the placenta and the uterine wall,
with the palm facing the placenta.
8. Proceed slowly all around the placental
bed until the whole placenta is detached from
the uterine wall.
9. Hold the placenta and slowly withdraw the
hand from the uterus, bringing the
placenta with it.
10. With the other hand, continue to provide
counter-traction to the fundus by pushing it in
the opposite direction of the hand that is
being withdrawn.
11. Palpate the inside of the uterine cavity to
ensure that all placental tissue has
been removed
12. Give oxytocin 20 units in 1L IV fluid( normal
saline or Ringer’s lactate) at 60 drops per
minute.
13. Ask an assistant to massage the fundus
of the uterus to encourage a tonic uterine
contraction.
Problems
• If the placenta does not separate from the
uterine surface by gentle lateral movement of
the fingertips at the line of cleavage, remove
placental fragments.
• If there is continued heavy bleeding, give
ergometrine 0.2 mg IM or Prostaglandins
– Examine the women carefully and repair any tears to
the cervix or vagina or repair episiotomy.
• If the tissu is very adherent, suspect placenta
accreta and proceed to laparotomy and possible
subtotal hysterectomy.
• If the placenta is retained due to a constriction
ring or if hours or days have passed since
delivery, extract the placenta using two fingers,
ovum forceps or a wide curette
References
Managing Complications in Pregnancy and Child
birth:
A guide for midwives and doctors. World Health
Organization.Geneva,2003

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