of Pitocin is appropriate to encourage further contraction of the uterus. Once the uterus, cervical os, and vagina are cleared of placental and membranous fragments, an injection of 10 I.U. See Manual Removal of the Placenta and Membranes If there is any question about fragments of the placenta or membranes still remaining within the uterus, a manual sweep of the uterus is the next step. These may be teased out carefully with a ring forceps followed by gentle but firm massage of the uterus with the abdominal hand, to encourage contraction of the uterus. If there appears to be a placental or membranous fragment missing, inspect the vaginal canal and cervical os for evidence of trailing membranes, or other tissue. This inspection is detailed in the section Birth of the Normal Placenta: Procedures for Birth of the Normal Placenta, Section E. Therefore, immediate and careful inspection of the placenta and membranes should always be conducted as soon as the placenta is delivered. However, it is not uncommon to have the heavy bleed occur some minutes or hours later, following a smaller but continuous flow. Most often there will be continued bleeding after the placenta is out. The key to effective management is to ensure immediate recognition of retained fragments (cotyledons and/or membranes) in order to respond promptly before heavy blood loss ensues. Delivery with Retained Fragments of the Placenta or Membranes.Third stage labor problems, associated with the placenta, which may be identified just after the actual birth of the placenta include the following: Events Immediately After the Birth of the Placenta Nurse-Midwifery at University of Utah - Module2 - Tutorial 2 - Birth of the Placentaīirth of the Problem Placenta During Childbirth 3.
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