Manual Removal of Placenta

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:

  1. One is the midwife
  2. One is an assistant
  3. One is the woman
  4. One observer follows the guidelines in the Safe Delivery App
  5. 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
Remove gloves Same
Hand hygiene 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?