Retained Tissue [Drills]
Purpose: To be able to diagnose a missing piece of placenta and to remove it safely
- 15-30 minutes
- Safe Delivery App, MamaNatalie, elbow long gloves
- Video subchapter “Tissue”
The participants are divided into groups of five:
- One is the midwife
- One is an assistant
- One is the woman
- One observer follows the guidelines in the Safe Delivery App
- One instructor reads the drill and follows the checklist below
The following case is read aloud:
10 minutes after a normal delivery, Prisha suddenly starts to bleed heavily. The placenta was delivered 5 minutes post-partum. 20 minutes after delivery, the total amount of bleeding reaches 1100ml. Prisha is stable. Bleeding has stopped. A closer look at the placenta shows that there might be a part of a lobe missing.
Since Prisha is stable and the bleeding has stopped for now, you can spend time watching the video subchapter Retained Placenta / Placental Fragments in the Safe Delivery App (Post Partum Haemorrhage).
What could be the cause of bleeding?
What do you do? Step by step?
|What to expect the midwife to say||What to answer||Where to find in the Safe Delivery App|
|Remove tissue retained in the uterus||Post Partum Haemorrhage Video: Tissue|
|Give analgetics||Post Partum Haemorrhage Video: Tissue Drug list: Morphine and/or Diazepam|
|Perform hand hygiene||Post Partum Haemorrhage Video: Tissue|
|Elbow long sterile gloves||Sorry, out of stock||Same|
|Normal sterile gloves||Same|
|Ask for the woman’s consent||Same|
|Insert a flat hand into the uterus||Same|
|Support the top of the uterus with the other hand||Same|
|Keep fingers tightly together||Same|
|Carefully move the hand from side to side all around the uterus to remove fragments||Same|
|Withdraw the hand and the fragments||Same|
|Palpate the uterus carefully to make sure that all fragments have been removed.||Same|
|Broad spectrum antibiotics - E.g. 2 g Ampicillin IV||Same|
Evaluate the drill afterwards with the questions:
- What went well?
- What could be better?
- What did I learn?
Procedure for Vacuum Extraction [Drills]
Purpose: To learn how to protect the perineum during a vacuum birth