Retained Placenta

Question 1

When is the third stage of labour considered delayed?

Answer 1

If not completed by 30 mins with active management, by 60 mins with physiological 3rd stage
A placenta not delivered by this time is likely to not be expelled spontaneously

Question 2

What is the danger with retained placenta?

Answer 2

Haemorrhage

Question 3

What is it associated with?

Answer 3

Previous RP 
Uterine surgery
Preterm delivery
Maternal age >35
Placental weight <600g
Parity >5
Induced labour 
Pethidine used in labour

Question 4

If the placenta does not separate readily, what should be avoided?

Answer 4

Excessive cord traction - the cord may snap or the uterus invert

Question 5

How should it be managed?

Answer 5

Check that placenta is not in the vagina
Palpate abdomen
Rub up a contraction
Put the baby to the breast - stimulates oxytocin production
Give 20IU oxytocin in 20ml saline into umbilical vein and proximally clamp cord
Empty bladder - full bladder causes atony
If placenta still not delivered within further 30 mins offer examination to see if manual removal needed - stop if too painful
Theatre for manual removal

Question 6

Describe how manual removal is done

Answer 6

Mother in lithotomy position, using aseptic technique, place one hand on abdomen to stabilise uterus. Insert other hand through cervix and into uterus, follow cord to find placenta.
Gently work around placenta, separating it from uterus with ulnar bladder of hand. When separated, remove with cord traction.
Give oxytocin
One dose of antibiotic - cefuroxime 1.5g and metronidazole 500mg IV
Rarely placenta will not separate - senior help