Retained placenta  is lack of expulsion of all or part of the placenta within 30 minutes  during the third stage of labor. The third stage of labor is when you deliver the placenta and membranes. This usually takes 5 to 30 minutes. If the placenta is not out after 30 minutes, it is said to retained.  This condition can be fatal because it interferes with the normal contraction of the uterus and leads to severe postpartum bleeding.

What are the cause of a retained placenta  ?

The three main causes of a retained placenta include the following :

• Trapped placenta : The placenta successfully comes out of the uterus but gets trapped behind the closed cervix
• Uterine atony : This is when the uterus stops contracting or does not contract enough  for the placenta to separate from the  uterine wall
• Placenta accreta : This is when part of the placenta remains attached because it is deeply embedded in the uterine wall

Sometimes a full bladder may prevent the placenta from  being delivered. In this case the health care provider will insert a catheter to drain the bladder.  The placenta may sometimes adhere to a fibroid or a scar from a previous cesarean.

What are the complications associated with retained placenta ?

After the placenta is expelled, the uterus  normally contracts  down to close  off the blood vessels in the uterus.  If there is partial separation of the placenta , the uterus cannot contract properly and the blood vessels continue to bleed. Heavy bleeding in the first 24 hours after birth is known as primary postpartum hemorrhage. Sometimes small fragments of the placenta and membranes are retained and not detected immediately. This causes infection and heavy bleeding later on. This is known as secondary postpartum hemorrhage.

How is retained placenta treated ?

The placenta may be removed manually . A regional anesthesia such as a spinal or epidural  will be administered.  You can also ask for a general anesthesia if you prefer. The health care professional will insert a catheter to drain the bladder and an  intravenous IV antibiotics to prevent infection before removing the placenta manually. She will place her hands into the uterus to gently separate the placenta from the uterine wall. She will then gently  withdraw the placenta from the uterus. After the removal , you will be given medications through IV to help the uterus contract down. The uterus is also massaged to help it contract. Blood transfusion may be performed if  blood loss is significant.

Rarely the placenta will not separate from the uterus. This is common in the case of placenta accreta. In this case , an emergency hysterectomy is performed. Blood transfusions are also common in these cases.

NOTE

This condition is common in premature babies than full term babies. You are also at high risk if you’ve had a previous retained  placenta.