Manual exploration of the uterine cavity to verify the integrity of the uterus and remove any placental debris or blood clots interfering with retraction and, hence, haemostasis.
– Suspected uterine rupture.
– Suspected retained products after examination of 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).
– Follow precautions common to all intrauterine procedures (Section 9.1.1) and specific precautions for manual procedures (Section 9.1.2).
– Systematic 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.