What is a Retained Placenta?

Giving birth does not end once you deliver your brand new baby boy or girl, though it may feel that way to you! The final stage of labor is actually when your placenta delivers. Usually, this happens in a matter of minutes and goes smoothly, but in some cases, the placenta will not detach, and all or part of it will remain in the uterus. This is known as a retained placenta and complicates about 2 percent of all births.

While the placenta usually delivers minutes after the birth of your baby, it can be normal for it to take slightly longer than this. It is considered abnormal, however, if the placenta still remains in the uterus after 30 minutes.

This can happen for a few different reasons: the placenta has grown into the wall of the uterus abnormally and cannot detach (such as in a placenta accreta), the cervix has started to close up again, or the uterus has an abnormal shape that may be blocking the passage of the placenta.

While it may seem harmless to just wait longer, having a retained placenta can keep the uterus from contracting down. This can lead to excessive bleeding and possibly a postpartum hemorrhage. Because of this, once a retained placenta is diagnosed, steps must be taken to remove it promptly.

The first step that is usually taken is an attempt to remove the placenta manually. This means the obstetric provider will place his or her hand into the uterus and try to manually separate the placenta from the wall of the uterus to pull it out. This can often only be done if pain medications (such as an epidural or intravenous medication) are used.

If this is not successful, a trip to the operating room is usually necessary. Here a spinal or epidural can be placed, and the patient can be more closely monitored. An ultrasound may be done in the operating room to help figure out why it might not be detaching. Another effort at manual removal may be tried, or an instrument may be used to “scrape off” the placenta from the wall of the uterus.

If the placenta is still completely or partially retained after these efforts, if bleeding is severe, or if the mother’s life is in danger, additional surgical procedures may be required. This may include opening the uterus to remove the placenta or removing the uterus entirely via a hysterectomy. Medications can also be given during all these measures to try and help the uterus contract down and expel the placenta, as well.

Sometimes the placenta appears to deliver complete, and in a matter of hours or days a woman develops symptoms such as increased bleeding or signs of infection (fever, abdominal pain, abnormal smelling vaginal discharge). These can be signs that a small piece of the placenta is still in the uterus, and an ultrasound can confirm this. This condition is often treated with a surgical procedure called a dilation and curettage (“D&C”) to remove the remaining tissue. Antibiotics or medications to help with bleeding may need to be given as well.

Sources:

• AD Weeks
• The retained placenta
• Afr Health Sci
• 2001 Aug; 1(1): 36–41.

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