9.3 Uterine exploration


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.

9.3.1 Indications

– 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).

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).
– 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.