Manual placenta removal is an obstetrical procedure, usually administered by a physician or midwife. The medical procedure involves the removal of a retained placenta after childbirth. Medical professionals are trained to monitor the mother after she has delivered her baby, waiting for the subsequent delivery of the placenta. If the placenta is not delivered within 30 minutes after birth or its delay is accompanied by excessive bleeding, the medical professional must manually remove the organ from the uterus. In the procedure, usually administered under general or local anesthesia, the medical professional enters the birth canal with his or her hand and manually sweeps the cavity of the uterus to loosen the placenta.
The placenta is the small, kidney-shaped organ that attaches to the blood-rich interior cavity of the uterus and grows larger as the fetus develops. Through the placenta and its umbilical cord, the fetus receives oxygen and nourishment. After birth, the placenta's function ends and is normally expelled by uterine contractions shortly after birth. The doctor or midwife may knead the mother's abdomen to loosen the organ and instigate expulsion.
Complications indicating manual placenta removal arise when the placenta fails to descend into the birth canal. Manual placenta removal is an emergency procedure. Delay of placental birth may cause severe, fatal hemorrhaging. There is the threat of possible infection, especially septicemia as the blood-rich lining and blood vessels of the uterus are exposed and very vulnerable to bacteria. The procedure is also very painful, and the mother is usually sedated if possible.
In the manual placenta removal procedure, the medical professional places his or her hand on the mother's abdomen and applies pressure to the uterus within. The other hand follows the umbilical cord up the birth canal, through the cervix and into the uterine cavity. With a wide sweeping motion within the uterus, the physician inserts his or hand between the placenta and the wall of the uterus, similar to loosening the peel from an orange.
The causes of a retained placenta vary greatly. Uterus contractions occurring after birth may be insufficient, the cervix may have closed, or a constriction ring may block the path. More serious, the placenta may have broken apart inside the uterus, or the placenta may have developed and attached deeply into the uterine tissue, known as placenta accretam. Placenta accretam may require a hysterectomy, which is immediate surgical removal of the uterus, in order to prevent the mother from bleeding to death.