19 - Retained placenta

Summary

Many interventions are in practice for the management of retained placenta. The interventions are classified into first line and second line manoeuvres. The first line procedure involves the use of intra-umbilical vein oxytocin injection. When expectant and other methods have failed, the manual removal of the placenta will be attempted. In adherent placenta if there is active bleeding manual removal may be necessary. One third of all pregnant women in developing countries deliver at home. At home or in the community these deliveries are assisted either by relatives or trained/untrained traditional birth attendants (TBA). In communities where home deliveries are common, women and birth attendants should be educated about retained placenta and the need for prompt transfer in such cases. If there are no facilities to transfer to, medical treatment with the prostaglandin analogue misoprostol or prostaglandin E2 (sulprostone) can be tried.