A woman delivers vaginally. At 20 minutes postpartum, the placenta has not been delivered. There is no active bleeding. What is the appropriate management sequence?
- A Immediate manual removal of placenta under general anesthesia
- B Oxytocin infusion, controlled cord traction, and if retained beyond 30 minutes, manual removal ✓
- C Wait 60 minutes before any intervention as placenta separates by gravity
- D Bimanual uterine compression and observation for 45 minutes
Correct answer: B. Oxytocin infusion, controlled cord traction, and if retained beyond 30 minutes, manual removal
Explanation
A retained placenta is defined as failure to deliver within 30 minutes of birth. Initial management includes ensuring bladder is empty, IV oxytocin, and controlled cord traction (Brandt-Andrews maneuver). If the placenta is not delivered by 30 minutes (some guidelines 60 minutes with oxytocin infusion), manual removal under spinal/epidural or general anesthesia is performed. Immediate manual removal at 20 minutes without waiting and attempting oxytocin is not standard unless there is active hemorrhage.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.