Question

While conducting a delivery, you perform the maneuver shown below. Following this, there is incomplete separation of the placenta and massive hemorrhage. What is your next step in management?

• A. Start oxytocin infusion and wait for spontaneous delivery of placenta
• B. Uterine massage
• C. Arrange for blood and use Crede’s method for placental delivery
• D. Manual removal of placenta

Answer 1

The Correct Option is D

In the scenario of obstetrics where there is incomplete separation of the placenta followed by a massive hemorrhage after a specific maneuver during delivery, the priority is rapid management to prevent serious maternal complications. Here's how you would manage this situation:

1. Identify the need for intervention: When there is massive hemorrhage and the placenta has not completely separated, it's crucial to act swiftly to control bleeding and prevent maternal shock.
2. Select appropriate management: The options for managing incomplete placental separation and hemorrhage include:
   • Start oxytocin infusion and wait for spontaneous delivery of placenta - This is often considered for more stable situations without severe hemorrhage.
   • Uterine massage - While this can help in cases of uterine atony, it is not primarily used for incomplete placental separation.
   • Arrange for blood and use Crede’s method for placental delivery - Crede's method may not be ideal in severe hemorrhage.
   • Manual removal of placenta: This is the most appropriate step in management when there is significant bleeding and incomplete placental separation. This method involves manually detaching and extracting the placenta to promptly address the bleeding source.
3. Explanation of the selected option:
   The correct answer is manual removal of placenta. This option is chosen due to the urgency of controlling hemorrhage caused by retained placental tissue. Manual removal is a definitive procedure that directly addresses the issue by manually separating the adherent placenta tissue from the uterine wall, thereby stopping the bleeding effectively.

The critical objective in obstetrics is to stabilize the patient by swiftly addressing the cause of hemorrhage. Manual removal is a key intervention in the case of retained placenta with significant hemorrhage, aligning with standard obstetric practices to ensure maternal safety.