I was taught that if doing a manual removal would effectively save the woman's life, then that was the best option. Obviously a risk vs benefit type of situation. The doctor I trained with did the occasional manual removal at home rather than the time challenging option of transferring, and always with the woman's cooperation. I work rurally, and sometimes the speed of the bleed and the distance from hospital would equal real damage to the woman. As I said in my posting, I have not had to perform a manual removal, but I can and would if it was a life saving procedure.
I thought the hospital acted very dangerously by delaying many aspects of their management of the PPH I witnessed last year, and that all up, a manual removal there and then would have been the quickest and safest option. Instead the woman went on to lose much more blood over another 40 minutes or so until in theatre, and then faced the choice of transfusion. I found that management very scary.
I have witnessed one manual removal in a hospital on the delivery bed after the cord tugging GP/Obs broke the cord whilst trying to extract the placenta (after a forceps delivery). He simply went straight in after the placenta and delivered it quite quickly. The woman was not too perturbed!! (and hadn't had any drugs either).
So I guess it's a matter of training, attitude, access and appropriateness - all to be assessed in a very short time frame if a real bleed is occurring.
Sue
I am a bit confused here - can you please explain how you do manual removal in the home situation? Surely this is too dangerous a procedure to do at home? Thanks Sue
----- Original Message ----- *From:* Marilyn Kleidon <mailto:[EMAIL PROTECTED]> *To:* ozmidwifery@acegraphics.com.au <mailto:ozmidwifery@acegraphics.com.au> *Sent:* Monday, February 28, 2005 1:34 PM *Subject:* Re: [ozmidwifery] MORE ACTIVE MANGAEMENT
Totally agree Sue. I was taught manual removal too and exactly the same re when to apply gentle but firm CCT. However, for a manual removal at home you do need maternal cooperation and did have one incidence in Seattle where we had to transfer for prolonged moderate/heavy blood loss that just would not settle and uterus that kept getting boggy. Para 3 with several years between each of the births, third birth being precipitous, placenta delivered easily (dirty duncan if you know what I mean) physiologically but bleeding would not subside and mum kept soaking a pad in an hour, could not stand a hand going past the introitus and was happy to go to the hospital. Estimated blood loss was 1600mL including theatre, a pin head size piece of membrane was all they could find. Mum declined transfusion and was home the next day tired but happy.
marilyn
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