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Placenta
Miftacul huda
FAA 111 0023
Manual Placenta
Manual removal procedure placenta is
implantation of the placenta from the uterine
wall and remove it from the uterine cavity
manually. In general, wait until 30 minutes
into the birth of the placenta spontaneously
or with light pressure on the fundus that
contract. If after 30 minute placenta can not
be separated so as not yet born or if the
waiting time bleeding that much, placenta
should be released immediately.
Procedures
1. Approval of Medical Measures
Informed consent is consent from
the patient and family to the medic
actions to be performed on him by a
doctor. Approval was given after the
patient is given a full explanation
and on the diagnosis of disease,
healing efforts, goals and courses of
action that will be performed.
4. Uteretonika (oxytocin,
ergometrine, prostaglandins)
5. Fluid NaCl 0.9% and RL
6. Infuse Set
7. The solution Antiseptic (Povidone
Iodine 10%)
8. Oxygen with regulator
2. Helper
a. Clothes room action, plastic
coatings, masks and goggles: 3 sets
b. Gloves DTT / sterile: preferably long
gloves
c. Footwear (rubber boots): 3 pairs
d. instrument
1) Kocher: 2, 5 ml syringes and needles
No.
23G
2) where the placenta bowl: 1
3) Rubber Catheter and urine bag: 1
4) Yarn kromk 2/0: 1 roller
5) Partus sets
placental release
mechanism
Start an IV infusion.
Provide emotional support and
encouragement. Give pethidine and
diazepam IV slowly (do not mix in the
same syringe) or use ketamine.
Give a single dose of prophylactic
antibiotics:
- ampicillin 2 g IV PLUS metronidazole
500 mg IV;
- OR cefazolin 1 g IV PLUS metronidazole
500 mg IV.
Empty the bladder
Let go of the cord and move the hand up over the abdomen in order to
support the fundus of the uterus and to provide counter-traction during
removal to prevent inversion of the uterus
Note: If uterine inversion occurs, reposition the uterus.
Move the fingers of the hand laterally until the edge of the placenta is
located.
If the cord has been detached previously, insert a hand into the
uterine
cavity. Explore the entire cavity until a line of cleavage is identified
between the placenta and the uterine wall.
Detach the placenta from the implantation site by keeping the fingers
tightly together and using the edge of the hand to gradually make a
space between the placenta and the uterine wall.
Proceed slowly all around the placental bed until the whole placenta is
detached from the uterine wall.
If the placenta does not separate from the uterine surface by
gentle lateral
movement of the fingertips at the line of cleavage, suspect placenta
accreta and proceed to laparotomy and possible subtotal hysterectomy.
Hold the placenta and slowly withdraw the hand from the uterus,
bringing the placenta with it With the other hand, continue to provide
counter-traction to the fundus by pushing it in the opposite direction of
the hand that is being withdrawn.