The various medical interventions that can be used will depend on what the caregiver feels is the cause of the retained placenta and if the woman is heavily bleeding.
The most common interventions can include:
Oxytocin injections
Manual removal of the placenta
Umbilical vein Injection
Oxytocin injections. In most cases the 3rd stage will be actively managed, so an oxytocin injection (usually Syntocinon) will more than likely already have been given during the birth of the baby. If the woman is having a naturally managed 3rd stage, then the caregiver may only give this injection if the placenta is retained and / or the woman is heavily bleeding.
Another oxytocin injection (called Ergometrine) is usually avoided as it can close the cervix too soon and retain the placenta, even if the placenta successfully separates. This is because the drug causes a very strong, constant contraction that is more likely to entrap the placenta rather than release it. Ergometrine may be given in an emergency situation as a 'stop gap' solution to control heavy bleeding before the placenta is manually removed. Oxytocin Injections are discussed in
Class 7 .
Manual removal of the placenta. Manual removal of the placenta (also known as MROP) is the most common treatment for a retained placenta. It involves the caregiver (usually the doctor) placing one hand into the woman's vagina, through the cervix and into the uterus. The caregiver feels for where the placenta is attached and uses their fingers to lift the placenta off the wall of the uterus.
Ideally this procedure is done using a general or epidural anaesthetic. Occasionally, in an emergency situation where the woman is bleeding heavily, there may be no time to administer the anaesthetic, and the procedure may be attempted with the woman using the gas.
From the 1960's to 1980's some caregivers performed a manual removal of the placenta 'routinely' (along with a forceps birth, using stirrups and giving an