A 24-year-old woman delivers vaginally at term. The third stage is managed with oxytocin 10 IU IM, early cord clamping, and controlled cord traction. The placenta delivers at 12 minutes but appears incomplete. She bleeds 600 mL over the next 10 minutes. The uterus is well-contracted. What is the most appropriate next step?
- A Manual removal of placenta under anesthesia ✓
- B Uterine curettage immediately
- C Misoprostol 600 mcg rectally
- D Exploration of the genital tract for lacerations
Correct answer: A. Manual removal of placenta under anesthesia
Explanation
Retained placental tissue with a well-contracted uterus and ongoing bleeding warrants manual removal of the placenta under anesthesia. Curettage is avoided in the immediate postpartum period due to uterine perforation risk. Misoprostol is for atony, which is excluded here. Genital tract exploration is indicated when the uterus is contracted but bleeding persists, but retained tissue takes priority when the placenta is visibly incomplete.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.