Manual Placenta Course Materials

MANUAL PLACENTA STEPS / ACTIVITIES Preparation PREPARATION BEFORE PATIENT PREPARATION ACTIONS Explain to the patient and family the actions that will be taken Prepare approval for medical treatment for the patient's family Prepare the patient for the procedure:The mother is in the lithotomy position on the bed labor. TOOLS PREPARATION Prepare the necessary tools and medicines: Parturition set: Sterile handscreen Like an instrument Amnitom (1/2 kocher) Episiotomy scissors Umbilical cord clamp Cut the umbilical cord Central cord tying Crooked De Lee slime sucker Long sterile gloves Hold the placenta Sterile gauze, 3 ml DTT syringe cotton and needle no. 23G Cuching medicine Heacting set: Like an instrument Nailpouder 10 cc syringe Handscoen Tweezers Nail heacting (for skin, for muscles) Cut gut thread Doek is sterile Stethoscope Spighnomanometer Thermometer Baby resuscitation equipment Cunam piper/ long cunam Apron, mask, protective glasses, boots (PPE) cloth cover (blanket, cover) Mom's clothes Baby clothes Towels, washcloths Plastic basin Iron basin Book/pen for documentation DTT/sterile gloves 0.5% chlorine solution Uterotonics (Ergometrine maleate, Oxytocin) Local anesthetics (Lidocaine 2%) Aquabidest Povidone-iodine Catheter Standard infusion Infusion set (abocath 16 or 18) RL Infusion Fluid HELPING PREPARATIONS Wear personal protection Wash your hands with soap and running water then dry them with a clean and dry tissue or personal towel Implementation Install RL infusion Practice vulva hygiene Put on a clean and dry butt pad THE ACTION OF PENETRATION INTO THE UTERINE CAVUM Perform verbal anesthesia so that the mother's attention is diverted from the pain or illness Perform bladder catheterization: Make sure the catheter is inserted correctly Remove the catheter after the bladder has been emptied Wear long DTT or sterile gloves then clamp the umbilical cord with a clamp/kocher, then tension the umbilical cord parallel to the floor Obstetrically, insert one hand (back of hand down) into the vagina by tracing the underside of the umbilical cord Once the hand reaches the opening of the cervix, ask an assistant or family member to holding the kocher, then the other helping hand holds the uterine fundus. While holding the uterine fundus, insert the hand into the uterine cavity until it reaches placental implantation site Open the obstetrician's hand in a greeting (thumb close to the base of the finger index finger) REMOVING THE PLACENTA FROM THE UTERINE WALL Determine placental implantation, find the lowest edge of the placenta When implanting the posterior corpus, the hand remains on the lower side of the umbilical cord. If implantation is in the anterior corpus, move the inner hand to the upper side of the umbilical cord with the back of the hand facing upwards Implantation in the posterior corpus: Remove the placenta from the implantation site by slipping the fingertips between the placenta and the uterine wall, with the back of the hand on the back wall of the uterus (facing the underside of the umbilical cord). Implantation in the anterior corpus: Insert the fingertip between the placenta and the uterine wall with the back of the hand on the front inner wall of the uterus (facing the upper side of the umbilical cord) Then move the inner hand to the left and right while shifting cranially so that all maternal surfaces of the placenta can be released Note: while carrying out the action, pay attention to the condition of the mother (patient), take appropriate treatment if complications/problems occur REMOVING THE PLACENTA While one hand is still in the uterine cavity, perform a repeat exploration for ensure that no part of the placenta is still attached to the uterine wall. Move the outer hand to the suprasymphysis to hold the uterus while the placenta issued Do a slight push of the uterus (with the outside hand) dorsocranially. Instruct the assistant or family member holding the kocher to pull the umbilical cord while Hands in pulling the placenta out (avoid blood splashes) Place the placenta in the place provided Note: Pay attention to uterine contractions and the amount of bleeding that comes out PREVENTION OF POST-ACTION INFECTIONS While still wearing gloves, collect all items, materials or used instruments and clean the mother's body and the action bed. Decontaminate gloves and all equipment contaminated with blood or other body fluids in a container containing 0.5% chlorine Remove gloves and immediately wash your hands with soap and clean running water. Dry your hands with a clean, dry personal towel POST ACTION CARE Check the patient's vital signs again, immediately take action and instructions if they persistrequired Record the patient's condition and make an action report in the column provided. Make further treatment instructions and important things to monitor Tell the patient and his family that the procedure has been completed but the patient is still there requires care Teach mother and family about self-care and possible signs of danger happen. Ask the family to immediately report to helpers if there is a problem with the mother's health or if any signs of danger arise DOCUMENTATION Document the actions that have been taken