Retained placenta 2013–15

RETAINED PLACENTA

INTRODUCTION Timely removal of the placenta reduces risk of severe obstetric haemorrhage. If placenta

has not delivered or shown signs of separation 20 min after administration of syntometrine or oxytocin, prepare to treat promptly for retained placenta after 30 min

If woman has requested a physiological third stage of labour and placenta has not delivered or shown signs of separation 60 min after birth, advise woman to allow active management of the third stage

While waiting for placenta to separate, follow Management below

Unnecessary delay increases risk of postpartum haemorrhage

MANAGEMENT Notify delivery suite co-ordinator that placenta has not delivered

Encourage skin-to-skin/baby to breast

Assist mother onto bed pan and encourage to empty bladder

if unsuccessful, catheterise

Ensure mother is warm

Ensure large bore IV cannula in situ and take blood for FBC and group & save

Unclamp cord from mother’s end

Obstetric registrar will perform vaginal examination and check placenta not detached in vagina

Do not attempt to remove an adherent placenta in delivery room or without anaesthetic

Manual removal of placenta takes priority over elective cases, even if woman not actively bleeding

obstetric SHO can undertake this procedure under the direct supervision of the obstetric registrar

if blood loss increases, accelerate transfer to theatre

Use gauntlets to protect the operator

Midwife can accompany woman into theatre to support her throughout

Administer broad spectrum IV antibiotics

Following placenta removal, obstetric registrar must ensure uterus is empty

Run oxytocin infusion for 4 hr after removal of placenta

These women should stay on delivery suite for at least 2 hr

Oral broad spectrum antibiotics for 5 days

In the case of postpartum haemorrhage – see Postpartum haemorrhage guideline Communication

Ensure woman and her partner, are fully informed at all times

Obstetric registrar will see woman the following day to answer questions, especially in view of the uniquely penetrative nature of the procedure

Inform woman of increased risk of placental retention in future pregnancy Documentation

Ensure clear and accurate documentation, including:

procedure used

total estimated blood loss since delivery

RETAINED PRODUCTS Where there is any concern about the completeness of delivered placenta, midwife must

notify obstetric registrar or equivalent regardless of mode of delivery

Insert cannula take blood for FBC and group & save

Where there is a confirmed incomplete placenta, take woman to theatre for evacuation of retained products as above for a retained placenta