- Beware abnormal placentation with previous section
- Controlled cord traction preferred
- Manual removal if retained placenta
- Wipe placental site with sponge or explore manually prn
- Bleeding from placental site?
- Deep compression sutures
- Uterine packing, exit through vagina
- Intrauterine balloon (Bakri) placement
- Intrauterine contraceptive device may be placed before uterine closure
Gentle traction on the cord will generally be sufficient to deliver the placenta intact and is the preferred method. Manual removal is also possible and may provide an educational opportunity to practice manual removal, sometimes required in a vaginal delivery situation.
The placenta bulges through the uterine incision as the uterus contracts. A hand holds the fundus to help aid spontaneous placental separation and the placenta is delivered with controlled cord traction.
Cord traction plus stabilization of the fundus to deliver the placenta. Some operators follow the delivery with sponging of the endometrium or manual currettage to ensure no tissue remains.