39

MANUAL REMOVAL OF PLACENTA, (R.C.O.G. TABLE 26)

DR. GEORGE HENRY

Summary: Booked

| Unbooked (a) Total number of cases . . . . . . . . . . . . 211 {Primipara

LMultipara Incidence against total deliveries 28 weeks

maturity and over (5,273) . . . . . . . . . 4 per cent.

(b) Maternal mortality . . . . . . . . . . . . Nil

Indications for manual removal:

Adherent placenta . . . . . . . . . . . . . . . . . . . . . 98 Failed ergometrine . . . . . . . . . . . . . . . . . . . . . 53 To facilitate exploration of genital tract . . . . . . . . . 52 Postpartum haemorrhage . . . . . . . . . . . . . . . . . . 7 Convenience at operative delivery . . . . . . . . . . . . . . . 1

=203 = 8 --~ 70 =141

COMMENT

There has been a considerable increase in the incidence of this procedure from the two previous years, 2.9 per cent. in 1964 and 1965 to 4 per cent. in 1966. This increase would appear to be due to the large number of placentae which are removed manually in order to facilitate exploration of the genital tract following instrumental delivery in patients with a previous Caesarean section scar.

Failed ergometrine technique includes placentae which are trapped by the cervix and also those cases in which the umbilical cord is t om off during the Brartdt-Andrews manoeuvre.

I t is routine hospital policy to have an intravenous fluid infusion running before embarking upon a manual removal of placenta so that blood trans- fusion can be commenced, if indicated, without delay.

The majority of manual removals are performed under general anaesthetic but in cases where a preliminary vaginal examination has revealed that the placenta is trapped due to failure of ergometrine technique satisfactory re- sults are obtained without resorting to a general anaesthetic.

INDUCTION OF LABOUR (R.C.O.G. TABLE 28)

MASTER

Summary:

(a) Total number of cases . . . . . . . . . . . . 372 Incidence against total deliveries at all periods

of pregnancy (5,767) . . . . . . . . . . . . 6.4 per cent.