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Retained placenta in all care

settings guideline (GL904)

Approval
Approval Group Job Title, Chair of Committee Date
Maternity & Childrens Services Chair, Maternity Clinical 8th May 2015
Clinical Governance Committee Governance Committee

Change History
Version Date Author, job title Reason
7.0 Nov 2009 M Selinger, Consultant in Reviewed
Fetomaternal medicine
8.0 Jan 2012 P Street, Consultant in Reviewed
Fetomaternal medicine
9.0 May 2014 P Street, Consultant in Reviewed
Fetomaternal medicine
9.1 Jan 2015 M Selinger, Consultant in Amendment to pg 3 addition of
Fetomaternal medicine reference to GL787 for antibiotic
treatment
10.0 April 2015 A Weavers (Consultant Updated NICE CG190, published
Midwife) December 2014.
L Randall (Consultant
Midwife trainee)

Author: A Weavers, L Randall Date: May 2015


Job Title: Consultant Midwife, Consultant midwife trainee Review Date: May 2017
Policy Lead: Group Director Urgent Care Version: 10.0 ratified 8th May
2015 Mat CG mtg
Location: Maternity CG Shared drive/ Intrapartum/ GL904
This document is valid only on date Last printed 16/06/2015 13:13:00 Page 1of 4
Maternity Guidelines Retained Placenta in all care settings (GL904) May 2015

Overview: Occurs at 2% term confinements. Manage by minimising risk and arranging


manual removal.

Definition - The placenta is 'retained' if undelivered 1 hour after the birth of the baby/ies.

Management if at home
Explain to the woman and her birth companion(s) what is happening
Call paramedics
Establish IV access and explain to the woman why this is needed
Observe and record blood loss
Record maternal BP, pulse and respiratory rate every 15 minutes and record on
MOWs chart
Inform and transfer to delivery suite
Oral Ranitidine 150 mg should be given as soon as possible if none has been
administered during labour

Management if in IBC
Explain to the woman and her birth companion(s) what is happening
Inform delivery suite
Establish IV access and explain to the woman why this is needed
X match 2 units blood
Observe and record blood loss
Record maternal BP, pulse and respiratory rate every 15 minutes and record on
MOWs chart
Transfer to delivery suite
Oral Ranitidine 150 mg should be given as soon as possible if none has been
administered during labour

Management on Delivery Suite


Explain to the woman and her birth companion(s) what is happening
Establish IV access and explain to the woman why this is needed
Do not use intravenous oxytocic agents routinely to deliver a retained placenta
Give intravenous oxytocic agents if the placenta is retained and the woman is
bleeding excessively
Do not use umbilical vein agents if the placenta is retained
Take blood for Hb., Gp. & save
BP, pulse and respiratory rate at 15 minute intervals and record on MOWs chart
unless otherwise indicated
Inform Registrar i/c delivery suite who will assess the woman to determine the need
for manual removal of placenta. If the woman is offered a vaginal examination to
Author: A Weavers, L Randall Date: May 2015
Job Title: Consultant Midwife, Consultant midwife trainee Review Date: May 2017
Policy Lead: Group Director Urgent Care Version: 10.0 ratified 8th May
2015 Mat CG mtg
Location: Maternity CG Shared drive/Intrapartum/ GL904
This document is valid only on date Last printed 16/06/2015 13:13:00 Page 2 of 4
Maternity Guidelines Retained Placenta in all care settings (GL904) May 2015

assess the need to undertake manual removal of the placenta, explain that this
assessment can be painful and advise her to have analgesiaIf the woman reports
inadequate analgesia during the assessment, stop the examination and address
this immediately
Do not carry out uterine exploration or manual removal of the placenta without an
anaesthetic
Inform anaesthetist i/c delivery suite - ERPC requires a spinal, epidural or general
anaesthetic
The placenta should be removed as soon as possible to reduce the risk of
postpartum haemorrhage, but the timing of MROP will depend on whether the
woman is bleeding and if not bleeding on the priority of cases waiting for theatre
Book theatre
Get consent
Catheterise
Antibiotics: See Antibiotics guideline for Obstetrics (GL787) for recommendations
Observe and record blood loss, monitor height fundus as although there is no
increase in vaginal blood loss the uterus may be filling with blood, leading to rise of
uterine fundus
Oral Ranitidine 150 mg should be given as soon as possible if none has been
administered during labour
Arrange check Hb 48 hours post procedure

This guideline will be monitored; results reviewed by audit forum committee and action
plans made if compliance with guideline not met.

Auditable standards
1. MOWs chart commenced & pulse, BP & respiratory rate recorded every 15 minutes
2. IV access achieved and blood sent
3. Blood loss observed and recorded and height uterine fundus monitored
4. MROP as soon as possible, any delays documented in maternal health record.

References:
1. National Institute for Clinical Excellence (2014) Intrapartum care: care of healthy
women and their babies during childbirth. NICE clinical guideline 190. NICE.
Available: http://www.nice.org.uk/guidance/cg190/resources/guidance-intrapartum-
care-care-of-healthy-women-and-their-babies-during-childbirth-pdf

Author: A Weavers, L Randall Date: May 2015


Job Title: Consultant Midwife, Consultant midwife trainee Review Date: May 2017
Policy Lead: Group Director Urgent Care Version: 10.0 ratified 8th May
2015 Mat CG mtg
Location: Maternity CG Shared drive/Intrapartum/ GL904
This document is valid only on date Last printed 16/06/2015 13:13:00 Page 3 of 4
Maternity Guidelines Retained Placenta in all care settings (GL904) May 2015

Author/s Mr. Mark Selinger (consultant in fetomaternal medicine)


Reviewed November 2006, October 2009, January 2012 (Pat Street), May 2014 (P
Street), January 2015 (M Selinger), March 2014 A Weavers (Consultant midwife) & L
Randall (Consult MW trainee) NICE CG190 changes
Review due May 2017

Author: A Weavers, L Randall Date: May 2015


Job Title: Consultant Midwife, Consultant midwife trainee Review Date: May 2017
Policy Lead: Group Director Urgent Care Version: 10.0 ratified 8th May
2015 Mat CG mtg
Location: Maternity CG Shared drive/Intrapartum/ GL904
This document is valid only on date Last printed 16/06/2015 13:13:00 Page 4 of 4