Category: RETAINED PLACENTA

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

Very late presentation with severe anemia and/or sepsis:

Supravaginal (subtotal) hysterectomy.

•