UNIVERSITY HOSPITALS OF MORECAMBE BAY NHS TRUST
WOMEN’S & CHILDREN’S DIRECTORATE
Following the publication of the NICE Guidelines this
guideline is to be introduced for a trial period for 2 months –
on going audit to assess outcomes
RETAINED PLACENTA
This is defined as failure to complete the third stage of labour within 30 minutes.
The initial management of the third stage is to give IM Syntometrine at delivery of the
anterior shoulder. When the placenta has not separated and delivered, despite
controlled cord traction (and breast feeding if appropriate):-
1. Catheterise the bladder
2. After 30 minutes the 1st on-call the 2nd on call should be informed and
3. Secure IV access – bloods should be taken for FBC, group & save and coagulation
screen.
4.
20iu of Syntocinon in 20mls of normal saline should be injected into the
umbilical vein, with proximal cord clamping
5. If bleeding is heavy the management should be as for PPH
6.
If Oxytocin is not effective within 30 minutes, arrangements should be made
for removal of the placenta under appropriate anaesthesia in theatre
7. The placenta should be removed digitally
The operators dominant hand is inserted into the uterus and following the cord
the placenta is reached. The lower edge should be identified and detached
from the uterus by the edge of the hand. When the whole placenta is separated
it is removed intact. The uterus should be carefully examined to ensure all the
tissue is removed and there are no perforations.
7. The patient should be given one dose of antibiotics to cover the manual removal -
Augmentin 1.2g IV, or if allergic to penicillin - Metronidazole 500mgs and
Cefuroxime
750mg IV
Ref:
ALSO Manual – Post partum Haemorrhage: Third Stage Emergency .J Anderson. D
Etches. D.Smith.
4th Edition 2000 – 2001
NICE (2007) Intrapartum Care. Care of healthy women and their babies during
childbirth. NICE Clinical Guideline 55.
OCTOBER 2007.KAG/PKM/JAP