Managing Complications in Pregnancy and Childbirth: - IAWG

Normal labour and childbirthC-77Never apply cord traction (pull) without applying counter traction(push) above the pubic bone with the other hand.• As the placenta delivers, the thin membranes can tear off. Hold theplacenta in two hands and gently turn it until the membranes aretwisted.• Slowly pull to complete the delivery.• If the membranes tear, gently examine the upper vagina and cervixwearing high-level disinfected gloves and use a sponge forceps toremove any pieces of membrane that are present.• Look carefully at the placenta to be sure none of it is missing. If aportion of the maternal surface is missing or there are tornmembranes with vessels, suspect retained placental fragments(page S-32).• If uterine inversion occurs, reposition the uterus (page P-91).• If the cord is pulled off, manual removal of the placenta may benecessary (page P-77).UTERINE MASSAGE• Immediately massage the fundus of the uterus through thewoman’s abdomen until the uterus is contracted.• Repeat uterine massage every 15 minutes for the first 2 hours.• Ensure that the uterus does not become relaxed (soft) after youstop uterine massage.EXAMINATION FOR TEARS• Examine the woman carefully and repair any tears to the cervix(page P-81) or vagina (page P-83) or repair episiotomy (page P-73).INITIAL CARE OF THE NEWBORN• Check the baby’s breathing and colour every 5 minutes.