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 | |
| 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?