Early presentation:

Induce delivery of the retained placenta:

  • Nitroglycerine sublingually or nasally
  • Misostoprol (Cytotec)  
  • Oxytocin

Late presentation:

Manual or instrumental removal:

  • Introduce one hand into the uterus
  • Use the ulnar border of the intrauterine hand to dissect the placenta from the uterine wall
  • Apply contra pressure on outside of the uterus with other hand on abdomen
  • In case a closed or closing cervix does not allow the entire hand to enter the intrauterine cavity, two fingers are usually sufficient
    • If not, use instruments
    • A large sponge forceps (ring forceps) will do
Manual Removal of Placenta

Very late presentation with severe anemia and/or sepsis:

Supravaginal (subtotal) hysterectomy.