| 1 |
If
you can see the placenta, ask the woman to push it out.
If you can feel the placenta in the vagina, remove it. |
| 2 |
Ensure
that the bladder is empty. Catheterize the bladder, if
necessary. |
| 3 |
If
the placenta is not expelled, give oxytocin 10 units
IM if not already done for active management of the third
stage. |
| 4 |
Do
not give ergometrine because it causes tonic uterine
contraction, which may delay expulsion. |
| 5 |
If
the placenta is undelivered after 30 minutes of oxytocin
stimulation and the uterus is contracted, attempt controlled
cord traction.
|
Avoid
forceful cord traction and fundal pressure as they may
cause uterine inversion.
|
| 6 |
If
controlled cord traction is unsuccessful, attempt manual
removal of placenta. Very adherent tissue may be placenta
accreta. Efforts to extract a placenta that does not
separate easily may result in heavy bleeding or uterine perforation
which usually requires hysterectomy. |
| 7 |
If
bleeding continues, assess clotting status using a bedside
clotting test. Failure of a clot to form after 7 minutes
or a soft clot that breaks down easily suggests coagulopathy. |
| 8 |
If
there are signs of infection (fever, foul-smelling vaginal
discharge), give antibiotics as for metritis. |
