Manual removal of placenta

1. Mrs.Jagadeeswari.J
M.Sc Nursing

2. Failure of placental
delivery within 30 minutes
after delivery of the fetus.

3. Manual placenta removal is
a procedure to remove a retained
placenta from the uterus after
childbirth

4. MRP is done under GA
If not available under deep sedation
Patient placed in lithotomy position
Bladder is catheterized

5.  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

6. 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.

7. 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


8. 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

9.  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being withdrawn.

10.  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.

11.  Examine the placenta for
completeness
 Check for contracted uterus

12.  Shock
 Postpartum haemorrhage
 Puerperal Sepsis
 Subinvolution
 Inversion
 Hysterectomy
 Embolism
 Thrombhophelebitis