A 29-year-old G3P2 delivers vaginally. The placenta is retained for 45 minutes with active bleeding of 400 mL. Two attempts at controlled cord traction with fundal pressure have failed. The patient has received oxytocin 10 IU IV. What is the next step in management?
- A Continue waiting for spontaneous expulsion up to 60 minutes
- B Uterine packing with gauze
- C Manual removal of placenta under anesthesia ✓
- D Hysterectomy
Correct answer: C. Manual removal of placenta under anesthesia
Explanation
When the placenta is retained beyond 30 minutes with active bleeding, manual removal under anesthesia is indicated. The traditional 30-minute threshold applies to vaginal delivery. Waiting beyond 30 minutes with ongoing bleeding increases maternal risk. Uterine packing is not effective for retained placenta. Hysterectomy is a last resort for uncontrolled hemorrhage after all conservative measures fail.
Reference: Dutta's Textbook of Obstetrics, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.