Manual Removal of Placenta, commonly known as MROP, is an emergency obstetric procedure performed when the placenta fails to deliver spontaneously within the normal third stage of labor. In Nigerian maternity units, the standard definition marks prolonged third stage at 30 minutes following the birth of the baby with active management, or sooner if excessive bleeding occurs. Delaying intervention exposes the mother to profound postpartum hemorrhage and shock. The procedure involves the midwife or doctor introducing a gloved hand directly into the uterine cavity, locating the placental edge, and performing a sweeping motion with the side of the hand to separate the placenta cleanly from the uterine wall.
MROP is a painful and invasive intrauterine procedure that requires careful preparation to prevent infection and manage pain. Adequate analgesia or regional anesthesia must be established before the hand enters the vagina. Intravenous access with a large-bore cannula is mandatory to allow rapid fluid replacement and administration of uterotonic drugs. Strict aseptic technique is non-negotiable because the open uterine wound is highly vulnerable to ascending bacteria. Midwives must wear sterile long-sleeved gowns and gloves that reach past the elbows, ensuring the entire forearm entering the birth canal remains sterile.
While MROP is lifesaving, it carries significant risks that every maternity clinician must monitor closely. Uterine perforation can occur if excessive or unguided force is used, particularly with a softened postpartum myometrium. Postpartum hemorrhage may persist if pieces of the placenta are left inside or if the uterine muscle fails to contract after extraction. Severe intrauterine infection or endometritis is another major hazard due to the introduction of organisms during manual manipulation. Clinicians must also watch for signs of profound shock resulting from blood loss and pain.
Following a successful MROP, the patient requires intensive monitoring to catch early signs of secondary bleeding or infection. Immediately administer prescribed uterotonics such as oxytocin or misoprostol to maintain firm uterine contraction. Monitor vital signs—blood pressure, pulse rate, and temperature—every 15 minutes for the first hour, then according to hospital protocol. Inspect lochia color, amount, and odor regularly, and check the uterine fundus for tone and height. Administer prophylactic antibiotics as ordered to protect against ascending genital tract infections.