Expulsion of placenta -
Only when the features of placental separation and its descent into the lower segment
are confirmed, the patient is asked to bear down simultaneously with the hardening of
the uterus. The raised intra-abdominal pressure is often adequate to expel the placenta.
If the patient fails to expel. one can wait safely upto 10 minutes if there is no bleeding.
As soon as the placenta passes through the introitus, it is grasped by the hands and
twisted round and round with gentle traction so that the membranes are stripped intact.
If the membranes threaten to tear, they are caught hold of by sponge holding forceps and
in similar twisting movements the rest of the membranes are delivered.
If the spontaneous expulsion fails or is not practicable, because of delivery under
anaesthesia, any one of the following methods can be used to expendite expulsion.
i) Controlled cord traction -
The palmar surface of the fingers of the left hand is placed (above the symphysis pubis)
approximately at the junction of upper and lower uterine segment. The body of the uterus
is pushed upwards and backwards, towards the umbilicus while by the right hand steady
tension (but not too strong traction) is given in downward and backward direction holding
the clamp until the placenta comes outside the introitus. The procedure is to be adopted
only when the uterus is hard and contracted.
ii) Fundal pressure -
The fundus is pushed downwards and backwards after placing four fingers behind the
fundus and the thumb in front using the uterus as a sort piston. The pressure must be
given only when the uterus becomes hard. If it is not, then make it hard by gentle rubbing.
The pressure is to be withdrawn as soon as the placenta passes through the introitus.
The uterus is massaged to make it hard, which facilitates expulsion of retained clots if any.
Injection of oxytocin (5-10) I.V. or methergin 0.2 mg is given intramuscularly.
Oxytocin is more stable and has lesser side effects.
Only when the features of placental separation and its descent into the lower segment
are confirmed, the patient is asked to bear down simultaneously with the hardening of
the uterus. The raised intra-abdominal pressure is often adequate to expel the placenta.
If the patient fails to expel. one can wait safely upto 10 minutes if there is no bleeding.
As soon as the placenta passes through the introitus, it is grasped by the hands and
twisted round and round with gentle traction so that the membranes are stripped intact.
If the membranes threaten to tear, they are caught hold of by sponge holding forceps and
in similar twisting movements the rest of the membranes are delivered.
If the spontaneous expulsion fails or is not practicable, because of delivery under
anaesthesia, any one of the following methods can be used to expendite expulsion.
i) Controlled cord traction -
The palmar surface of the fingers of the left hand is placed (above the symphysis pubis)
approximately at the junction of upper and lower uterine segment. The body of the uterus
is pushed upwards and backwards, towards the umbilicus while by the right hand steady
tension (but not too strong traction) is given in downward and backward direction holding
the clamp until the placenta comes outside the introitus. The procedure is to be adopted
only when the uterus is hard and contracted.
ii) Fundal pressure -
The fundus is pushed downwards and backwards after placing four fingers behind the
fundus and the thumb in front using the uterus as a sort piston. The pressure must be
given only when the uterus becomes hard. If it is not, then make it hard by gentle rubbing.
The pressure is to be withdrawn as soon as the placenta passes through the introitus.
The uterus is massaged to make it hard, which facilitates expulsion of retained clots if any.
Injection of oxytocin (5-10) I.V. or methergin 0.2 mg is given intramuscularly.
Oxytocin is more stable and has lesser side effects.
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