Complications of manual removal of placenta is/are

Ans. d (All of the above) (Ref. Obstetrics dutta, 6th ed., p 414)MANUAL REMOVAL OF PLACENTA# Manual removal is accomplished by developing a cleavage plane with the intrauterine hand between the maternal surface of the placenta and the uterine wall, while simultaneously fixing the uterus with the abdominal hand, and progressively peeling the placenta free.# To ensure complete placental removal, a 4-inch by 4-inch gauze may be wrapped around the hand and used to abrade the uterine wall.# The placenta should then be carefully inspected for cord insertion, confirmation of a three-vessel cord (infants with only two cord vessels have a higher rate of malformations and warrant closer evaluation by the newborn caregiver), and completeness of the placenta and membranes.# If any portion of the placenta or the membranes is missing, the uterine cavity should be manually explored.# Some advocate routine exploration of the uterine cavity to reduce the risk of infection and bleeding from retained placental fragments.# In most women, especially those without regional anesthesia, the benefit of manual exploration is outweighed by the discomfort it causes, as well as the increased risk for uterine infection.