Giving birth is undoubtedly a miraculous process. An amazing organ is known as the placenta, nurtures your baby in the womb throughout your pregnancy. The placenta provides all the nutrients and oxygen to your baby and once the baby is delivered, the role of the placenta also finishes. The placenta is then expelled during the third stage of labor. But it does not always come out easily, resulting in retained placenta.
Retained placenta refers to the condition in which the placenta fails to fully expel from the uterus subsequent to the delivery of the infant. In certain cases, a fragment of the placenta may remain in the uterine cavity. Although infrequent, the condition can have significant implications. Postpartum complications may arise several days or weeks following delivery. The retention of the placenta has the potential to result in significant maternal morbidity, including but not limited to life-threatening hemorrhage or severe infection.
What Is A Retained Placenta?
Typically labor happens in three stages:
- Stage 1: In this stage, you start to feel the contractions which cause changes in your cervix and prepare it for delivery
- Stage 2: Your baby is delivered in this stage
- Stage 3: This is the stage when the placenta which is responsible for taking care of your baby all this while is expelled from the body
Occasionally, the delivery of the placenta may exceed the anticipated timeframe. If the whole or a part placenta or membranes remain inside your womb for more than 30 minutes after your baby is born, then it is known as the retained placenta. If the retained placenta is left untreated, it can cause complications that can be life-threatening.
What Causes A Retained Placenta?
A placenta usually remains retained due to five main causes:
- Trapped Placenta: In this case, the placenta detaches from the uterus but becomes stuck behind the cervix, which closes before the placenta exits the body.
- Placenta Adherens: Here, a part or the entire placenta attaches firmly to the wall of the uterus, making it difficult to expel.
- Placenta Accreta: In rare cases, a part of the placenta grows deeply into the uterine wall. This condition, known as placenta accreta, often occurs when the placenta attaches to a scar from a previous C-section.
- Uterine Atony: This is the most common cause of a retained placenta. It occurs when the uterus fails to contract or does not contract strongly enough to push the placenta out.
- Succenturiate Lobe: Sometimes, a small portion of the placenta—connected to the main placenta by a blood vessel—remains inside the uterus. This condition can also lead to retention.
Signs And Symptoms Of Retained Placenta
When you have a retained placenta in your body, you will experience the symptoms of it after a day. Some of the main signs and symptoms of retained placenta include:
- Vaginal discharge that has a foul smell and comprises tissue residue
- Persistent bleeding
- Fever
- Severe contractions and cramps
- Delay in the production of milk
What Are The Risk Factors For A Retained Placenta?
The main factors that can increase the risk of a pregnant woman include:
- Lobulated placenta
- Augmentation or induction of labor
- Premature delivery
- Earlier cases of retained placenta
- Previous uterine surgery
- Delivering a stillborn baby
- Getting pregnant after 35 years
- Extremely prolonged second or first stage of delivery
- Having had around five births earlier
If you have any of the above risk factors, then your doctor will be able to guide and assist you as to how to manage the third stage of labor.
How Is Retained Placenta Diagnosed?
In order to diagnose retained placenta, your doctor can carefully examine the expelled placenta to ensure that it is still intact. Any missing part is a cause for concern. In cases where the doctor was unable to diagnose a small part of the missing placenta, then the woman will start to experience the symptoms mentioned above after delivery.
If your doctor suspects retained placenta, then he will perform an ultrasound scan to check whether any part of the placenta is remaining in your womb. If this is the case, then immediate action is required to avert further complications.
Can You Separate The Retained Placenta?
Suppose the expulsion of the placenta is taking time after giving birth, breastfeeding your baby or rubbing the nipples is a good move as this will release oxytocin hormones. This triggers uterine contractions that will in turn help in expelling the placenta.
In a managed third stage of labor, if the placenta does not come out within an hour of delivery, the doctor will administer an oxytocin injection that will stimulate the contraction of the uterus. The doctor will assist in the expulsion of the placenta. However, if this does not happen, another dose of oxytocin injection along with saline is administered into the umbilical vein to help in placenta expulsion.
How Is A Retained Placenta Treated?
If the retained placenta has not come out even after the doctor has administered oxytocin and saline injections, then the doctor will do any one of the following:
- Manual placenta removal: The doctor manually removes the placenta using her hand. You won’t feel any discomfort because she will administer local anesthesia—either an epidural or spinal block. Once the anesthesia takes effect, she gently inserts her hand into your uterus and pulls out the placenta along with any remaining fragments. She also gives you intravenous antibiotics to prevent infection. After removing the placenta, she may administer additional intravenous medication to help your uterus contract.
- Curettage: The doctor first removes part of the placenta manually, then uses a curette to scrape out any remaining tissue embedded in the uterus.
- Hysterectomy: The doctor surgically removes the uterus, along with the placenta, usually when the placenta has grown deeply into the uterine wall, as seen in cases of placenta percreta.
- Controlled traction of the cord: If the placenta separates from the uterus but doesn’t exit the body, the doctor clamps the baby’s umbilical cord and gently pulls it to help remove the placenta.
What Are The Complications Of A Retained Placenta?
During a normal delivery, the uterus contracts to stop any bleeding. However, if a part of the placenta remains inside the uterus, it cannot contract properly, and the blood vessels continue to bleed. As a result, the uterus fails to close properly and cannot prevent blood loss.
If the placenta does not come out within half an hour after delivery, the risk of severe bleeding increases. Doctors refer to severe blood loss within the first twenty-four hours after birth as Primary Postpartum Hemorrhage.
If small fragments of the placenta remain in the uterus, they can later cause severe bleeding and infection. This condition, though quite rare, is known as Secondary Postpartum Hemorrhage.
How Can A Retained Placenta Be Prevented?
You cannot do much to prevent the retained placenta from occurring in the next pregnancy.
- If you have had a retained placenta in your previous delivery, the risk of having the same in the next delivery increases. Let your doctor know about this so that she pays more attention to the third stage of labor. Skin-to-skin contact with your baby will help to decrease the risk.
- The prolonged use of oxytocin during labor can cause retained placenta.
- After you give birth to your baby, your doctor will suggest that you massage your uterus. This encourages uterine contractions that help stop any bleeding and prepare the uterus to return to a smaller size.
Have you or anyone in your family faced the problem of retained placenta? Do let us know about your experience in the comments section below.
FAQs
1. What Is The Duration Of Retained Placenta?
This occurs when all or part of the placenta remains in the uterus for more than 30 minutes following delivery. An untreated retained placenta poses serious risks to the mother’s health.
2. Can A Retained Placenta Pass Naturally?
It is crucial to take measures to remove the it after delivery instead of waiting for it to expel naturally. Failure to do so may result in fatality for the mother.
3. Can You See Retained Placenta On Ultrasound?
If the doctor suspects a retained placenta, she conducts a physical examination and performs an ultrasound to confirm it.
