29/01/2026
đTopic: Delivery āĻāϰ āĻĒāϰ ā§Šā§Ļ āĻŽāĻŋāύāĻŋāĻ āĻšāϝāĻŧā§ āĻā§āĻā§, āĻāĻŋāύā§āϤ⧠Placenta āĻŦā§āϰ āĻšāϝāĻŧāύāĻŋ, āĻāϰ āĻŽāĻžā§ā§āϰ āϰāĻā§āϤāĻĒāĻžāϤ āĻŦāĻžā§āĻā§āĨ¤ āĻāĻāĻāύ āύāĻžāϰā§āϏ āĻā§āĻāĻžāĻŦā§ Retained Placenta suspect āĻāϰāĻŦā§āύ āĻāĻŦāĻ āĻāϰ āĻā§ āĻāϰāĻŖā§āϝāĻŧ āĻšāĻŦā§ - āĻā§āύ⧠āύāĻŋāύ đ
đ´ Retained Placenta āĻāĻāĻāĻŋ Obstetric emergency, āϝā§āĻāĻž delivery-āĻāϰ āĻĒāϰ ā§Šā§Ļ āĻŽāĻŋāύāĻŋāĻā§āϰ āĻŽāϧā§āϝ⧠placenta āĻŦā§āϰ āύāĻž āĻšāϞ⧠āϧāϰ⧠āύā§āĻāϝāĻŧāĻž āĻšāϝāĻŧāĨ¤
āϝāĻĻāĻŋ āĻāϰ āϏāĻžāĻĨā§ excessive vaginal bleeding āĻĨāĻžāĻā§, āϤāĻžāĻšāϞ⧠āĻāĻāĻž Retained Placenta with Postpartum Hemorrhage (PPH) āĻšāĻŋāϏā§āĻŦā§ āĻŦāĻŋāĻŦā§āĻāύāĻž āĻāϰāĻž āĻšāϝāĻŧ â āϝāĻž āύāĻžāϰā§āϏāĻĻā§āϰ āĻāύā§āϝ āĻāĻāĻĻāĻŽ critical situationāĨ¤
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Retained Placenta āϏāύā§āĻĻā§āĻš āĻāϰāĻžāϰ āĻāĻĒāĻžāϝāĻŧ (Nurseâs Assessment):
đš Time Monitoring:
âĒī¸Delivery-āĻāϰ āĻĒāϰ ā§Šā§Ļ āĻŽāĻŋāύāĻŋāĻ āĻšāϝāĻŧā§ āĻā§āĻā§ āĻāĻŋāύā§āϤ⧠Placenta āĻŦā§āϰ āĻšāϝāĻŧāύāĻŋ â āĻāĻāĻŋ āϏāĻŦāĻā§ā§ā§ āĻā§āϰā§āϤā§āĻŦāĻĒā§āϰā§āĻŖ Suspicion point.
đš Bleeding Observation:
âĒī¸āĻŽāĻžāϝāĻŧā§āϰ āϰāĻā§āϤāĻĒāĻžāϤ āϏā§āĻŦāĻžāĻāĻžāĻŦāĻŋāĻā§āϰ āϤā§āϞāύāĻžāϝāĻŧ āĻŦā§āĻļāĻŋ â Heavy vaginal bleeding is a red flag.
đš Uterus Assessment:
âĒī¸Uterus āϝāĻĻāĻŋ soft āĻ boggy āĻšāϝāĻŧ â uterine atony suspect āĻāϰāĻž āĻšāϝāĻŧ, āϝā§āĻāĻž retained placenta-āϰ āĻāĻžāϰāĻŖā§ āĻšāϤ⧠āĻĒāĻžāϰā§āĨ¤
âĒī¸Fundus āϝāĻĻāĻŋ āĻāĻĒāϰ⧠āĻāĻ ā§ āϝāĻžā§ āĻŦāĻž āĻ āĻŋāĻāĻāĻžāĻŦā§ contract āύāĻž āĻāϰ⧠â Placenta retention-āĻāϰ āĻāĻā§āĻāĻŋāϤāĨ¤
đš Pain / Discomfort:
âĒī¸Patient āϝāĻĻāĻŋ lower abdominal pain āĻŦāĻž feeling of fullness āĻ
āύā§āĻāĻŦ āĻāϰ⧠â Placenta retention āĻšāϤ⧠āĻĒāĻžāϰā§āĨ¤
đš Placenta Delivery Signs Absent:
âĒī¸Placenta separation signs (gush of blood, lengthening of cord, uterus becoming firm and globular) āĻĻā§āĻāĻž āύāĻž āĻā§āϞ⧠â Placenta now retained.
â
Nursing Management :
đ´ Immediate Actions:
1. Doctor/Obstetrician āĻā§ āĻĻā§āϰā§āϤ āĻāĻžāύāĻžāύ⧠(Call for Help)
âĒī¸ Retained placenta is a medical emergency â Immediate obstetric intervention āĻĻāϰāĻāĻžāϰāĨ¤
2. Patient-āĻāϰ Condition Stabilize āĻāϰāĻž:
âĒī¸Vital Signs Check: BP, Pulse, Respiration āĻĻā§āϰā§āϤ āĻĒāϰā§āϝāĻŦā§āĻā§āώāĻŖ āĻāϰāϤ⧠āĻšāĻŦā§āĨ¤
âĒī¸Bleeding Measurement: āĻāϤāĻāĻž āϰāĻā§āϤāĻĒāĻžāϤ āĻšāĻā§āĻā§ āϏā§āĻāĻž observe āĻ document āĻāϰāϤ⧠āĻšāĻŦā§āĨ¤
âĒī¸IV Access Establish: āĻ
āύā§āϤāϤ ā§§āĻāĻž āĻŦā§ bore cannula (18G or 16G) āϞāĻžāĻāĻžāύā§āĨ¤
âĒī¸Normal Saline / Ringer's Lactate āĻĻāĻŋāϝāĻŧā§ fluid resuscitation āĻļā§āϰ⧠āĻāϰāϤ⧠āĻšāĻŦā§āĨ¤
3. Uterine Massage āĻļā§āϰ⧠āĻāϰāĻž:
âĒī¸ Fundal massage āĻāϰ⧠uterus āĻā§ contract āĻāϰāĻžāϰ āĻā§āώā§āĻāĻž āĻāϰāϤ⧠āĻšāĻŦā§āĨ¤
4. Oxytocin Administration:
âĒī¸Doctor-āĻāϰ āύāĻŋāϰā§āĻĻā§āĻļā§ Inj. Oxytocin (10 IU IM āĻŦāĻž IV infusion) āĻļā§āϰ⧠āĻāϰāĻž āϝā§āϤ⧠āĻĒāĻžāϰ⧠uterine contraction āĻŦāĻžā§āĻžāϤā§āĨ¤
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Retained Placenta āϝāĻĻāĻŋ āĻŦā§āϰ āύāĻž āĻšāϝāĻŧ āϤāĻžāĻšāϞ⧠āϏāĻŽā§āĻāĻžāĻŦā§āϝ Management:
âĒī¸Manual Removal of Placenta (MROP): Sterile environment-āĻ, anesthesia āĻĻāĻŋā§ā§ doctor Placenta manually remove āĻāϰāĻŦā§āύāĨ¤
âĒī¸Antibiotic Prophylaxis: Infection prevent āĻāϰāϤ⧠broad-spectrum antibiotics āĻĻā§āĻā§āĻž āĻšā§āĨ¤
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Documentation āĻāϰāϤ⧠āĻšāĻŦā§ :
âĒī¸Delivery time āĻāĻŦāĻ Placenta āύāĻž āĻŦā§āϰ āĻšāĻāϝāĻŧāĻž āĻĒāϰā§āϝāύā§āϤ āĻāϤ āϏāĻŽāϝāĻŧ āĻšāϝāĻŧā§āĻā§āĨ¤
âĒī¸Blood loss-āĻāϰ āĻĒāϰāĻŋāĻŽāĻžāĻŖ āĻ āĻāϰāĻŋāϤā§āϰāĨ¤
âĒī¸Vital signs āĻāĻŦāĻ nursing interventionsāĨ¤
âĒī¸Doctor āĻāĻāύ informed āĻšā§ā§āĻā§āύ āĻ āĻā§ āϏāĻŋāĻĻā§āϧāĻžāύā§āϤ āύāĻŋā§ā§āĻā§āύāĨ¤
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