MANAGEMENT OF OBSTETRIC CARE WITH PLACENTAL RETENTION DURING THE THIRD STAGE OF  LABOR IN MRS. Y AT TUTUN-SEHATI  CLINIC 2025

Yarni Kristiani Zai; Rahmi Larasati; Erin Fadilla Siregar; Desi Boang Manalu; Salmiah

Authors

Yarni Kristiani Zai Sekolah Tinggi Ilmu Kesehatan Mitra Husada Medan
Rahmi Larasati Sekolah Tinggi Ilmu Kesehatan Mitra Husada Medan
Erin Fadilla Siregar Sekolah Tinggi Ilmu Kesehatan Mitra Husada Medan
Desi Boang Manalu Sekolah Tinggi Ilmu Kesehatan Mitra Husada Medan
Salmiah Klinik Pratama Tutun Sehati

Keywords:

Placental Retention, Midwifery Care, Postpartum Hemorrhage, Manual Removal Of Placenta, Varney Management

Abstract

Retained placenta is an obstetric emergency that occurs when the placenta fails to be expelled within 30 minutes after delivery despite Active Management of the Third Stage of Labor (AMTSL). The incidence of retained placenta is estimated at 0.5–3% of all vaginal deliveries worldwide and remains one of the leading causes of postpartum hemorrhage, contributing substantially to maternal morbidity and mortality, particularly in low- and middle-income countries. Although retained placenta has been widely investigated, limited evidence is available regarding the practical implementation of Helen Varney's seven-step midwifery management approach integrated with WHO and FIGO recommendations in primary maternity care settings. This study provides clinical evidence from a primary healthcare facility to support evidence-based midwifery practice. Objective: This study aimed to analyze the application of Helen Varney’s seven-step midwifery management approach in managing retained placenta during the third stage of labor in a multiparous woman. Methods: A descriptive case study design was employed. Data were collected through anamnesis, direct observation, physical examination, abdominal palpation, genital tract exploration, and review of medical records. Data were analyzed descriptively by comparing clinical findings and interventions with recommendations from the World Health Organization (WHO), the International Federation of Gynecology and Obstetrics (FIGO), and evidence-based midwifery literature. Results: Mrs. Y, a 32-year-old multiparous woman (P2A0), experienced retained placenta 30 minutes after spontaneous vaginal delivery. Clinical findings included continuous vaginal bleeding, inadequate uterine contractions, blood pressure of 100/70 mmHg, pulse rate of 92 beats per minute, and respiratory rate of 24 breaths per minute. Emergency management consisted of fluid resuscitation, bladder catheterization, manual placental removal, uterotonic administration, and close monitoring. The placenta was successfully removed without complications, uterine contractions improved, bleeding was controlled, and the maternal condition stabilized. Conclusion: Helen Varney’s seven-step management approach provided a systematic framework for the early diagnosis, emergency intervention, and evaluation of retained placenta. The implementation of evidence-based midwifery care contributed to successful maternal outcomes and the prevention of severe postpartum hemorrhage.

References

Adnan, Naufal Ikbar Rian, And Freddy Dinata. 2025. “P3a0 Dengan Retensio Plasenta.” Prepotif : Jurnal Kesehatan Masyarakat 9(2):4753–58. Doi:10.31004/Prepotif.V9i2.48356.

American, College Of Obstetricians And Gynecologists Acog. 2026. Postpartum Hemorrhage.

Asfia, Fida, And Erina Rahmayanti. 2022. “Determinan Kejadian Perdarahan Post Partum Karena Retensio Plasenta.” Journal Of Baja Health Science 2(02):158–71. Doi:10.47080/Joubahs.V2i02.2195.

Favilli, Alessandro, Valentina Tosto, Margherita Ceccobelli, Fabio Parazzini, Massimo Franchi, Vittorio Bini, And Sandro Gerli. 2021. “Risk Factors For Non-Adherent Retained Placenta After Vaginal Delivery: A Systematic Review.” Bmc Pregnancy And Childbirth 21(1):1–13. Doi:10.1186/S12884-021-03721-9.

Franke, Denise, Julia Zepf, Tilo Burkhardt, Philipp Stein, Roland Zimmermann, And Christian Haslinger. 2021. “Retained Placenta And Postpartum Hemorrhage: Time Is Not Everything.” Archives Of Gynecology And Obstetrics 304(4):903–11. Doi:10.1007/S00404-021-06027-5.

Jiang, Wen, Wei Chen, And Dong Li. 2023. “Racial And Ethnic Disparities In The Incidence, Healthcare Utilization, And Outcomes Of Retained Placenta Among Delivery Hospitalizations In The United States, 2016–2019.” Bmc Pregnancy And Childbirth 23(1):1–10. Doi:10.1186/S12884-023-06097-0.

Manurung, Herna Rinayanti, Indri Heny Damanik, And Hesti Desmawati Gulo. 2024. “Faktor-Faktor Yang Mempengaruhi Kejadian Retensio Plasenta Pada Ibu Bersalin Di Rsup Haji Adam Malik Medan Tahun 2024 Penelitian Ini Menggunakan Desain Penelitian Analitik Observasional Dengan Pendekatan Kasus Kontrol Guna Mendalami Hubungan Sebab-Akibat.” Forum Ilmiah Dan Diskusi Mahasiswa(Forisma).

Marliani, Hermiati, Lestari Margareth Siamamora, And Juliana Munthe. 2022. “Continuity Of Care (Coc) Midwifery Care For Mrs. K—Covering Pregnancy, Childbirth, The Postpartum Period (Including Management Of Sore Nipples), The Newborn, And Family Planning—At The Independent Midwifery Practice Of Naimah Wanara, Aceh Province, 2021.” Jurnal Ilmu Kesehatan Dan Sains 2(1):41–51.

Marliani, And Ribun Sinaga. 2023. “Jurnal P3k (Penelitian Pendidikan, Psikologi Dan Kesehatan)(1).” 23.

Nainggolan, Anna Waris. 2024. “Faktor-Faktor Yang Berhubungan Dengan Kecemasan Ibu Postpartum Pada Masa Persalinan Di Rsu Vina Estetika Medan Tahun 2023.” 2(3).

Oktapianti, Rika, And Dempi Triyanti. 2025. “Faktor-Faktor Yang Berhubungan Dengan Kejadian Retensio Plasenta Di Pmb Desi Fitriani Palembang Tahun 2022.” Jidan Jurnal Ilmiah Kebidanan 5(1):156–64.

Perlman, Nicola C., And Daniela A. Carusi. 2019. “Retained Placenta After Vaginal Delivery: Risk Factors And Management.” International Journal Of Women’s Health 11:527–34. Doi:10.2147/Ijwh.S218933.

Rezeki, Sri, Amelia Erawaty Siregar, Erin Padilla Siregar, Damayanty S, Marta Armita Silaban, Novita Andriani Br Manjorang, And Anna Waris Nainggolan. 2024. “Implementasi Yoga Dalam Mengurangi Nyeri Dismenorea Pada Remaja Putri Di Desa Bangun Rejo Kecamatan Tanjung Morawa Kabupaten Deli Serdang Tahun 2025.” Excellent Community Service Journal 2(1):306–12.

Sari, Febriana, Oca Floren Simanullang, Malona Siregar, And Aqila Desky. 2026. “Manajemen Asuhan Kebidanan Pada Ny . N Dengan Plasenta.” Jurnal Pembangunan Kesehatan Dan Kesejahteraan Sosial 10(1):11–14.

Sianturi, Effendi. 2024. “Hubungan Pengetahuan Dan Sikap Bidan Tentang Retensio Dengan Penatalaksanaan Manual Plasenta Di Wilayah Kerja Puskesmas Huta Rakyat Sidikalang.” Jurnal Ilmiah Pannmed (Pharmacist, Analyst, Nurse, Nutrition, Midwivery, Environment, Dentist) 10(2):139–46. Doi:10.36911/Pannmed.V10i2.250.

Siti Nurmawan Sinaga. 2025. “Continuity Of Midwifery Care For Mrs. F Experiencing Umbilical Cord Entanglement At Mandrehe Health Center, Mandrehe District, West Nias Regency, In 2025.” 5(October).

Surbakti, Imran Saputra, Kamelia Sinaga, Lia Nurpiani3, Rumondang Sitorus, Asnita Sinaga, And Ribur Sinaga. 2024. “Efektifitas Penggunaan Injeksi Oksitosin Pada Penanganan Perdarahan Post Partum Di Rsu Latersia Binjai Kec . Binjai Kota Binjai Provinsi.” Jurnal Siti Rufaidah 2(2).

Syalfina, Agustin Dwi, Sari Priyanti, And Dian Irawati. 2021. “Manajemen Kebidanan Pada Ibu Bersalin Dengan Retensio Plasenta Midwifery Management In Maternal Maternity With Placenta Retention Sekolah Tinggi Ilmu Kesehatan Majapahit Mojokerto Agustinpipin2@Gmail.Com ; Jln . Raya Gayaman Km . 02 Mojoanyar Mojokerto Pe.”

Jurnal Manajemen Kesehatan Yayasan 7(2):150–61.

Takaji, Ryo, Hiro Kiyosue, Miyuki Maruno, Norio Hongo, Ryuichi Shimada, Satomi Ide, Kohei Tokuyama, Mamiko Okamoto, Yasushi Kawano, And Yoshiki Asayama. 2021. “Angiographic Features And Transarterial Embolization Of Retained Placenta With Abnormal Vaginal Bleeding.” Cvir Endovascular 4(1). Doi:10.1186/S42155-021-00265-Z.

Tchuinte Lekuikeu, Lucie Sorelle, And Connie Moreland. 2022. “Retained Placenta And Postpartum Hemorrhage: A Case Report And Review Of Literature.” Cureus 14(4). Doi:10.7759/Cureus.24389.

Uamiro, Gusrida. 2020. “Hubungan Antara Umur, Paritas, Dan Anemia Dengan Kejadian Retensio Plasenta Pada Ibu Bersalin Di Indonesia Tahun 2020.” Jurnal Antara Kebidanan 3(3):919–24. Https://Orcid.Org/0000-0002-2942-4013.

World Health Organizarion Who. 2020. Who Recommendation On Umbilical Vein Injection Of Oxytocin For The Treatment Of Retained Placenta. Vol. 1.

World Health Organization. 2023. Who Recommendations On The Assessment Of Postpartum Blood Loss And Use Of A Treatment Bundle For Postpartum Haemorrhage.