Retained Placenta: Causes, Symptoms And Treatment
5 min readWritten by Pradeep
Giving birth is undoubtedly a miraculous process. An amazing organ known as 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 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. Keep reading to know what it is, what its causes, symptoms are and what is done to bring it out.
What Is Retained Placenta?
Typically labor happens in three stages:
- Stage 1 : In this stage you start to feel the contractions which causes changes in our cervix and prepares 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
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 retained placenta.
If retained placenta is left untreated, it can cause complications that can be life threatening.
What Causes A Retained Placenta?
A placenta normally gets retained due to three main causes which include:
- Trapped placenta: This happens when the placenta detaches itself from the uterus but gets stuck at the back of the cervix which closes before the placenta has been expelled from the body
- Placenta adherens: This is a case when a part or whole placenta gets firmly stuck to the wall of the uterus
- Placenta accrete: Sometimes a part of the placenta remains deeply embedded in the uterine wall and this condition although rare is called placenta accrete. This normally occurs when your placenta attaches itself onto a scar that has arisen during a previous C section
- Uterine atony: This is most common type of retained placenta that normally happens when the uterus stops contracting or does not contract enough in order to push out the placenta
- Succenturiate lobe: Another reason that can cause retained placenta is when a tiny part of the placenta that is attached to the main placenta by a blood vessel, remains in the uterus
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 of tissue residue
- Persistent bleeding
- Fever
- Severe contractions and cramps
- Delay in production of milk
What Are The Risk Factors For A Retained Placenta?
The main factors that can increase the risk of a pregnant woman to have a retained placenta include:
- Lobulated placenta
- Augmentation or induction of labor
- Premature delivery
- Earlier cases of retained placenta
- Previous uterine surgery
- Delivering a still born 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 of concern.
In cases where the doctor was unable to diagnose a small part of 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.
How 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 will have to remove the placenta by manually using her hand. You will not feel any discomfort as you will be given local anesthesia either epidural or spinal. Once the anesthesia starts working, your doctor will insert her hand very gently into your uterus and pull the placenta and any part that is remaining in the body. You will be given antibiotics intravenously to avert any kind of infection. After removing the placenta manually, your doctor may give you more drugs intravenously to help the uterus to contract
- Curettage : Here the doctor partially removes the placenta manually. He then makes use of a curette to scrape the remnants of the placenta embedded in the uterus
- Hysterectomy: This is a surgical removal of placenta and mostly done in case the placenta is deeply grown in the uterus as in case of placenta percreta
- Controlled traction of cord: This happens when the placenta is separated from the uterus but fails to come out of the body. The doctor clamps baby’s umbilical cord and then tries to gently pull it to help get rid of the placenta from the body
What Are The Complications Of A Retained Placenta?
In a normal delivery, the contraction of the uterus occurs in order to stop any bleeding. However, if a part of the placenta is retained inside the uterus, it is unable to contract properly causing blood vessels to bleed continuously. Your uterus will not be able to properly close and thus prevent any blood loss.
If the expulsion of the placenta takes more than half an hour after delivery, the chances of severe bleeding increases. Severe loss of blood in the first twenty-four hours after birth is known as Primary Postpartum Hemorrhage.
If small fragments of the placenta are left behind in the uterus, it can cause severe bleeding and infection later. This case is known as Secondary Postpartum Hemorrhage which is quite rare.
How Can A Retained Placenta Be Prevented?
- You cannot do much to prevent retained placenta occurring in 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 of retained placenta
- The prolonged use of oxytocin during labor can cause retained placenta. Avoid any use to these artificial labor inductions to avoid the risk of retained placenta, C section and uterine scar
- 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.
Pradeep,
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