**6. Management of high risk areas by ground level workers**

### **6.1 Retained placenta and placental fragments**

The placenta is said to be retained if it is not delivered within half an hour of the birth ofthe baby. Bleeding may or may not occur in cases of retained placenta.

Retained placental fragments or pieces of membrane will cause PPH. This can be suspected if a portion of the maternal surface of the placenta is missing or the membranes with their vessels are torn. If placenta is partially separated or retained then it will cause continuous vaginal bleeding which further leads to PPH. Manage such cases as in the case of PPH [27].


### **6.2 Puerperal sepsis**

It is the infection of the genital tract from the time rupture of membranes or labor and till 42 days after delivery. Any two or more of the following signs and symptoms are present.

• Presence of Fever >38°C


Fever in the Postnatal period can occur because of the causes other than puerperal sepsis like mastitis, non obstetric causes or may be Urinary tract infection (UTI) etc. [27]

In this case, combination of antibiotics is given for at least 48 hours with following regime.


Oral antibiotics are not necessary after stopping IV antibiotics.
