3. Events Immediately After the Birth of the PlacentaThird stage labor problems, associated with the placenta, which may be identified just after the actual birth of the placenta include the following:
The key to effective management is to ensure immediate recognition of retained fragments (cotyledons and/or membranes) in order to respond promptly before heavy blood loss ensues. Most often there will be continued bleeding after the placenta is out. However, it is not uncommon to have the heavy bleed occur some minutes or hours later, following a smaller but continuous flow. Therefore, immediate and careful inspection of the placenta and membranes should always be conducted as soon as the placenta is delivered. This inspection is detailed in the section Birth of the Normal Placenta: Procedures for Birth of the Normal Placenta, Section E.
If there appears to be a placental or membranous fragment missing, inspect the vaginal canal and cervical os for evidence of trailing membranes, or other tissue. These may be teased out carefully with a ring forceps followed by gentle but firm massage of the uterus with the abdominal hand, to encourage contraction of the uterus.
If there is any question about fragments of the placenta or membranes still remaining within the uterus, a manual sweep of the uterus is the next step. See Manual Removal of the Placenta and Membranes
Once the uterus, cervical os, and vagina are cleared of placental and membranous fragments, an injection of 10 I.U. I.M. of Pitocin is appropriate to encourage further contraction of the uterus.
Bleeding after the placenta is delivered is usually due to one or more of the following three reasons:
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