A 27-year-old primigravida at 39 weeks undergoes induction of labour with oxytocin. She delivers vaginally but the placenta does not deliver after 30 minutes. There is minimal bleeding. She has no history of previous cesarean section. According to NICE guidelines, what is the recommended management at this point?
- A Proceed to manual removal of placenta ✓
- B Administer oxytocin 10 IU IV and wait another 15 minutes
- C Continue waiting for spontaneous expulsion up to 60 minutes
- D Perform ultrasound to confirm placental location
Correct answer: A. Proceed to manual removal of placenta
Explanation
NICE guidelines recommend manual removal of the placenta if it is not delivered within 30 minutes in the absence of bleeding, or immediately if bleeding is present. The traditional 30-minute threshold for the third stage applies when active management is used. Waiting beyond 30 minutes increases infection and hemorrhage risk.
Reference: NICE Guideline NG235: Intrapartum Care, 2023 ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.