Professional Documents
Culture Documents
Approval
Approval Group Job Title, Chair of Committee Date
Maternity & Childrens Services Chair, Maternity Clinical 8th May 2015
Clinical Governance Committee Governance Committee
Change History
Version Date Author, job title Reason
7.0 Nov 2009 M Selinger, Consultant in Reviewed
Fetomaternal medicine
8.0 Jan 2012 P Street, Consultant in Reviewed
Fetomaternal medicine
9.0 May 2014 P Street, Consultant in Reviewed
Fetomaternal medicine
9.1 Jan 2015 M Selinger, Consultant in Amendment to pg 3 addition of
Fetomaternal medicine reference to GL787 for antibiotic
treatment
10.0 April 2015 A Weavers (Consultant Updated NICE CG190, published
Midwife) December 2014.
L Randall (Consultant
Midwife trainee)
Definition - The placenta is 'retained' if undelivered 1 hour after the birth of the baby/ies.
Management if at home
Explain to the woman and her birth companion(s) what is happening
Call paramedics
Establish IV access and explain to the woman why this is needed
Observe and record blood loss
Record maternal BP, pulse and respiratory rate every 15 minutes and record on
MOWs chart
Inform and transfer to delivery suite
Oral Ranitidine 150 mg should be given as soon as possible if none has been
administered during labour
Management if in IBC
Explain to the woman and her birth companion(s) what is happening
Inform delivery suite
Establish IV access and explain to the woman why this is needed
X match 2 units blood
Observe and record blood loss
Record maternal BP, pulse and respiratory rate every 15 minutes and record on
MOWs chart
Transfer to delivery suite
Oral Ranitidine 150 mg should be given as soon as possible if none has been
administered during labour
assess the need to undertake manual removal of the placenta, explain that this
assessment can be painful and advise her to have analgesiaIf the woman reports
inadequate analgesia during the assessment, stop the examination and address
this immediately
Do not carry out uterine exploration or manual removal of the placenta without an
anaesthetic
Inform anaesthetist i/c delivery suite - ERPC requires a spinal, epidural or general
anaesthetic
The placenta should be removed as soon as possible to reduce the risk of
postpartum haemorrhage, but the timing of MROP will depend on whether the
woman is bleeding and if not bleeding on the priority of cases waiting for theatre
Book theatre
Get consent
Catheterise
Antibiotics: See Antibiotics guideline for Obstetrics (GL787) for recommendations
Observe and record blood loss, monitor height fundus as although there is no
increase in vaginal blood loss the uterus may be filling with blood, leading to rise of
uterine fundus
Oral Ranitidine 150 mg should be given as soon as possible if none has been
administered during labour
Arrange check Hb 48 hours post procedure
This guideline will be monitored; results reviewed by audit forum committee and action
plans made if compliance with guideline not met.
Auditable standards
1. MOWs chart commenced & pulse, BP & respiratory rate recorded every 15 minutes
2. IV access achieved and blood sent
3. Blood loss observed and recorded and height uterine fundus monitored
4. MROP as soon as possible, any delays documented in maternal health record.
References:
1. National Institute for Clinical Excellence (2014) Intrapartum care: care of healthy
women and their babies during childbirth. NICE clinical guideline 190. NICE.
Available: http://www.nice.org.uk/guidance/cg190/resources/guidance-intrapartum-
care-care-of-healthy-women-and-their-babies-during-childbirth-pdf