9.3 Uterine exploration

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    Manual exploration of the uterine cavity to verify the integrity of the uterus and remove any placental debris or blood clots interfering with contraction and, hence, haemostasis.

    9.3.1 Indications

    • Suspected uterine rupture.
    • Suspected retained products after examination of the expelled placenta.
    • Postpartum haemorrhage within 24 hours of delivery.
    • Routinely after manual removal of the placenta.

     

    Note: in the event of postpartum haemorrhage, rule out vaginal or cervical tear, especially if the placenta appears complete and the uterus is well-contracted (Chapter 8, Section 8.5).

    9.3.2 Technique

    • Follow precautions common to all intrauterine procedures (Section 9.1.1) and specific precautions for manual procedures (Section 9.1.2).
    • Routine uterine exploration: two faces, two sides, one fundus, two horns. Use the fingers to search for placental debris and remove by hand.
    • Ensure uterine retraction using abdominal massage: when the uterus retracts it resembles a firm ball.
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