Assisted Expulsion of Placenta
1. Controlled cord traction
(Modified brandt-andrews method)
Palmer surface place on above symphsis pubis
(Abdomen gently pushing uterus over uterus, upward and backward).
At same time traction is applied on umbilical cord (secure with haemostat or kocher's forceps) in direction downward and backward and then apply downwards till placenta and membrane are expelled completely.
Procedure is to be attempted only when uterus is hard and contracted.
Examination of placenta, membrane and cord done.
2. Fundal pressure
Fundus is pushed downwards and backwards after placing four finger behind the fundus and thumb infront of uterus or gently rubbing.
Pressure must give only when uteus become hard.
Uterine massage to make it hard.
Facilitates expulsion of retained clots.
Oxtocin (5-10units) or methergin (0.2mg) given IM.
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