Retained placenta with bleeding — emergency management station

Team-based emergency station: retained placenta complicated by haemorrhage in a woman at risk of accreta. Tests the bleeding-override decision, parallel resuscitation, honest appraisal of the failed medical options, manual removal technique, and the accreta stop rule. Includes assessor key and marking domains.

Prompt

A 33-year-old G2P1 with one previous caesarean has a spontaneous vaginal birth. The third stage was actively managed. At 35 minutes the placenta is undelivered and there is a steady trickle of blood; cumulative loss is 650 mL and rising. You are the registrar with the consultant 10 minutes away.

Station brief

Format. Emergency management station, approximately 12 minutes. You are the obstetric registrar on labour ward. The anaesthetist and a midwife are with you; the consultant is 10 minutes away and has been called. The assessor feeds you new observations and runs the clock. ^[1]

Candidate instruction. Lead the management of a bleeding retained placenta in a woman with a previous caesarean. Verbalise your decisions, your appraisal of the medical options, your preparation for theatre, and your communication with the team and the woman. ^[1]

References6Show

[1]Royal College of Obstetricians and Gynaecologists (RCOG) Prevention and Management of Postpartum Haemorrhage: Green-top Guideline No. 52 BJOG, 2017.PMID 27981719
[2]Weeks AD, Alia G, Vernon G, et al. Umbilical vein oxytocin for the treatment of retained placenta (Release Study): a double-blind, randomised controlled trial Lancet, 2010.PMID 20004013
[6]Denison FC, Carruthers KF, Hudson J, et al. Nitroglycerin for treatment of retained placenta: A randomised, placebo-controlled, multicentre, double-blind trial in the UK PLoS Med, 2019.PMID 31887169
[8]Kongwattanakul K, Pattanittum P, Jongjakapun A, et al. Prophylactic antibiotics for manual removal of retained placenta in vaginal birth Cochrane Database Syst Rev, 2024.PMID 39474979
[17]WOMAN Trial Collaborators Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial Lancet, 2017.PMID 28456509
[18]Kallianidis AF, Rijntjes D, van den Akker T, et al. Incidence, Indications, Risk Factors, and Outcomes of Emergency Peripartum Hysterectomy Worldwide: A Systematic Review and Meta-analysis Obstet Gynecol, 2023.PMID 36701608

Retained placenta with bleeding — emergency management station

Station brief

References6Show

[1]Royal College of Obstetricians and Gynaecologists (RCOG) Prevention and Management of Postpartum Haemorrhage: Green-top Guideline No. 52 BJOG, 2017.PMID 27981719
[2]Weeks AD, Alia G, Vernon G, et al. Umbilical vein oxytocin for the treatment of retained placenta (Release Study): a double-blind, randomised controlled trial Lancet, 2010.PMID 20004013
[6]Denison FC, Carruthers KF, Hudson J, et al. Nitroglycerin for treatment of retained placenta: A randomised, placebo-controlled, multicentre, double-blind trial in the UK PLoS Med, 2019.PMID 31887169
[8]Kongwattanakul K, Pattanittum P, Jongjakapun A, et al. Prophylactic antibiotics for manual removal of retained placenta in vaginal birth Cochrane Database Syst Rev, 2024.PMID 39474979
[17]WOMAN Trial Collaborators Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial Lancet, 2017.PMID 28456509
[18]Kallianidis AF, Rijntjes D, van den Akker T, et al. Incidence, Indications, Risk Factors, and Outcomes of Emergency Peripartum Hysterectomy Worldwide: A Systematic Review and Meta-analysis Obstet Gynecol, 2023.PMID 36701608