The Placenta usually takes 5 to 15 minutes to separate on its own and is expelled out after the birth of the baby.
What is retained placenta?
The placenta is said to be retained when the placenta or its membranes remain in the uterus and not expelled out even 30 minutes after the birth of the baby.
It is a rare complication in delivery, occurs in 3% of pregnancies. It is a very life-threatening condition and causes severe bleeding which needs immediate treatment; if left untreated, can put the life of the mother in danger.
What are the causes of retained placenta?
The causes of the retained placenta are-
- Uterine atonicity or inability of the uterus to contract properly in case of a mother with multiple births, prolonged labour, uterine malformation, overdistension of the uterus and the bigger placental surface area.
- Sometimes, the placenta may separate but retain due to poor voluntary expulsive efforts of the mother especially following exhaustive and prolonged labour.
- Placenta accreta is a very rare and abnormal condition in which the placenta is deeply attached to the uterine walls.
- Wrong technique to expel the placenta before it separates by inexperienced personnel.
- A full bladder may stop the adequate uterine contraction and retraction that causes difficulty in the expulsion of the placenta.
What are the symptoms of retained placenta?
The main symptom of the retained placenta is the placenta is not delivered within 30 minutes after the birth of the baby. In some conditions, the placenta may be delivered but some parts of the placental tissue or membranes may remain in the uterus leading to infection and heavy bleeding.
You may experience mild cramping, discomfort and passing of clots with bleeding which is normal but if you experience any of the following symptoms then you need to call your healthcare provider.
- Severe abdominal cramps with the passage of placental tissues or membranes with bleeding
- Foul-smelling vaginal discharge
- Fever due to infection
- Heavy bleeding
How is retained placenta diagnosed?
If your placenta has not been delivered within 30 minutes then you are diagnosed to have retained placenta.
The adherent placenta is diagnosed during manual removal. It is also diagnosed by noting the signs of absence of placental separation.
What are the risks associated with retained placenta?
The risks involved in prolonged retention of the placenta are-
- Severe bleeding
- Shock develops due to blood loss
- Puerperal sepsis
- Risk of recurrence in next pregnancy.
How is retained placenta treated?
Soon after the delivery of the baby, the mother is to be watched carefully to note the signs of separation of the placenta for 30 minutes. The bladder should be emptied using a rubber catheter. Intravenous fluids are started to decrease the risk of shock due to heavy blood loss.
Management of the retained placenta depends on the placenta whether separated, unseparated or complicated.
Separated retained placenta
If the placenta is separated but retained it should be expelled by controlled cord traction in which the cord is pulled slowly and bringing the placenta out.
Unseparated retained placenta
If the placenta is unseparated and retained then, manual removal of the placenta is to be done under general anaesthesia.
Complicated retained placenta
If the placenta is retained and also complicated by bleeding, shock, the infection then it is treated as follows-
- Retained Placenta with sepsis (infection): When a woman is delivered outside and admitted after a few hours or even days after delivery to the hospital. In this case, swabs are taken for testing and antibiotic is given to treat the infection. As soon as the general condition permits manual removal of the placenta is done.
- Retained placenta with an episiotomy wound: In this condition, the placenta is removed manually followed by repair of the episiotomy wound.
- Retained placenta with shock: In this, shock is treated first when the condition improves manual removal of the placenta is to be done.
In the above post, we discussed the retained placenta, its causes, symptoms, diagnosis, the risk associated with retained placenta and treatment.