| :: |
If
anaemia is severe, arrange for a transfusion and provide
oral iron and folic acid. |
| :: |
If
there are signs of infection (fever, foul-smelling vaginal
discharge), give antibiotics as for metritis:
| • |
Prolonged
or delayed PPH may be a sign of metritis. |
|
| :: |
Give
oxytocic drugs. |
| :: |
If
the cervix is dilated, explore by hand to remove large
clots and placental fragments. Manual exploration of
the uterus is similar to the technique described for removal
of the retained placenta. |
| :: |
If
the cervix is not dilated, evacuate the uterus to remove
placental fragments. |
| :: |
Rarely,
if bleeding continues, consider uterine and utero-ovarian
artery ligation or hysterectomy. |
| :: |
Perform
histologic examination of curettings or hysterectomy
specimen, if possible, to rule out trophoblastic tumour. |
