5.7 Care of the Mother Immediately after Delivery of the Placenta

The placenta should be examined carefully to detect abnormalities (infarcts, haematomas, abnormal insertion of the umbilical cord), but above all to ensure that it is complete. If there is a suspicion that part of the placenta is missing, preparations should be made to explore the uterine cavity. If part of the membranes are missing exploration of the uterus is not necessary.

In some countries it is customary for birth attendants routinely to explore the uterine cavity after every delivery, “uterine revision”. There is not the slightest evidence that such policy is useful; on the contrary, it can cause infection or mechanical trauma or even shock. The same holds true for another practice, the “lavage of the uterus”, the rinsing out or douching of the uterine cavity after delivery.

The mother should be observed carefully during the first hour postpartum. The most important observations include the amount of blood lost, and uterine fundal height: if the uterus contracts insufficiently blood may accumulate in the uterine cavity. If the blood loss is abnormal and the uterus is contracting poorly, gentle abdominal massage of the uterus can be helpful. It is essential to ensure that uterine contraction is not inhibited by the presence of a full bladder. Abnormal blood loss, estimated more than 500 ml, should be treated with oxytocics: ergometrine or oxytocin intramuscularly. The condition of the mother is also important: blood pressure, pulse and temperature, and general well-being should be assessed.