For the purpose of administering prophylactic antibiotics, manual removal is intended as any form of uterine manipulation, either manual or instrumentation within the uterine cavity for removing the placenta or exploring the cavity for any residual fragments.

• Current practice suggests that ampicillin or first-generation cephalosporins may be administered when manual removal of the placenta is performed. Alternatively, a single dose of intravenous amoxicillin (1 g) and clavulanic acid (200 mg) could be used, like the regimen used for operative vaginal birth. All regimens have a broad spectrum of activities and are widely available. When the recommended antibiotic classes are not available, other classes of antibiotics may also be used. The choice of such an antibiotic class should be informed by the local bacteriological patterns of infectious morbidity, the availability of such antibiotic class, the woman’s allergy history, the clinician’s experience with that class of antibiotics and cost.
• Infection prevention during and after manual removal of the placenta should not rely on antibiotics alone. Adherence to standard infection prevention and control practices, including hand hygiene and aseptic technique, remains essential. Prevention or promp