A pregnant lady has delivered a baby 35 minutes back. However, placenta has not been delivered. What should be the next line of management.
**Core Concept**
Retained placenta, also known as retained placental tissue or placental retention, is a condition where the placenta does not separate from the uterus after childbirth. This can lead to maternal complications such as hemorrhage, infection, and coagulopathy.
**Why the Correct Answer is Right**
The next line of management for retained placenta involves manual removal of the placenta, also known as manual placental extraction. This is typically performed by a skilled healthcare provider, ideally a trained obstetrician or midwife. The procedure involves gently separating the placenta from the uterine wall and removing it in one piece. This approach minimizes the risk of uterine trauma and bleeding. If manual removal is unsuccessful, the next step may involve surgical intervention, such as a dilation and curettage (D&C).
**Why Each Wrong Option is Incorrect**
**Option A:** Immediate uterotonic agents without attempting manual removal would be premature, as these medications may not be effective in the presence of retained placenta and may mask underlying bleeding.
**Option B:** Waiting for 1-2 hours to attempt manual removal may lead to increased risk of maternal complications, including hemorrhage and infection.
**Option C:** Proceeding with suturing the uterus without removing the placenta would be inappropriate, as this could lead to uterine trauma and bleeding.
**Clinical Pearl / High-Yield Fact**
In cases of retained placenta, it is essential to assess the patient's hemodynamic status and maintain a high index of suspicion for hemorrhage, infection, and coagulopathy.
**Correct Answer:** C. Manual removal of the placenta should be attempted by a skilled healthcare provider.