Retained placenta happens when your placenta isn’t delivered within 30 minutes of having your baby. Though it’s relatively uncommon and can be effectively treated, the condition does carry a serious risk of postpartum hemorrhage, or severe bleeding after childbirth. If you’re diagnosed, your medical team will try several different ways to remove the placenta, with surgery as a last resort. Retained placenta can’t be prevented, causes no symptoms when you’re pregnant, and won’t harm your baby.
IN THIS ARTICLE
- What is retained placenta?
- What causes retained placenta after birth?
- What are the risk factors for retained placenta?
- What are the symptoms of retained placenta?
- Are there serious risks of retained placenta?
- What are the treatments for retained placenta?
What is retained placenta?
Retained placenta occurs when your placenta isn’t delivered within 30 minutes of vaginal childbirth. It affects up to three percent of vaginal deliveries and is a common cause of postpartum hemorrhage, or heavy bleeding. Left untreated, the condition can be life-threatening.
To understand retained placenta, it helps to know about the third stage of labor, which happens after you’ve had your baby. During this time, you’ll feel a series of frequent, less-intense contractions. These are necessary to separate your placenta from your uterus so it can be delivered. When some or part of it is left behind, it can increase the risk of bleeding and infection later on.
What causes retained placenta after birth?
Retained placenta can be caused by a few issues. These include:
Trapped placenta. Also called an incarcerated placenta, a trapped placenta has disconnected fully from the uterine lining. It isn’t delivered, however, because the cervix has closed or started to close too soon. Your provider may be able to see a bit of the trapped placenta through a small opening in the cervix.
Uterine atony. The word “atony” means your muscles lack tone, tension, or energy. With uterine atony, your uterus doesn’t contract enough following childbirth, keeping the placenta from being pushed out.
Placenta accreta. In a small number of pregnancies, part or all of the placenta grows deeply into the uterus. As a result, the two organs don’t separate in the third stage of labor – creating a major bleeding risk – and a procedure is needed to detach them.
Placenta accreta usually doesn’t cause symptoms during pregnancy, though it’s occasionally discovered in an ultrasound. In this case, you’ll likely deliver via C-section and may need a hysterectomy afterwards. Often, the condition isn’t discovered until after you’ve given birth.
What are the risk factors for retained placenta?
Preterm delivery, especially during the second trimester, is the strongest risk factor for retained placenta. And if you’ve had the condition once, the odds are higher you’ll have it again in future pregnancies.
Other factors may also include:
- Maternal age of 30 or older
- IVF pregnancy
- Giving birth more than five times previously
- Prior uterine surgery, including C-section and dilation & curettage
- Uterine abnormality, meaning a malformation of your uterus
- Velamentous cord insertion, or when the placenta and umbilical cord are abnormally attached
- Preeclampsia
- Prolonged labor
- Prolonged use of oxytocin during delivery
- Having a baby who is small for their gestational age
- Stillbirth
Currently, there is no known way for you to lower the odds specifically of retained placenta. However, if you are high-risk, your delivery team can prepare for the possibility. Once you are admitted to a hospital or birthing center, they can run tests and gather the right pain medication and needed equipment, just in case it happens.
What are the symptoms of retained placenta?
You very likely won’t have any symptoms of retained placenta prior to delivery. From time to time, women experience bleeding in their third trimester.
The primary symptom is when all or part of the placenta isn’t delivered following childbirth, or if you begin bleeding heavily without delivering the placenta.
You may notice symptoms up to two weeks after you have your baby. These can include fever, foul-smelling discharge, heavy bleeding, and blood clots or large pieces of tissue coming out of your vagina. Make sure to report them to your provider right away.
Are there serious risks of retained placenta?
Yes. Retained placenta is a major cause of postpartum hemorrhage. The longer it takes you to deliver it, the higher your chances of this complication. If you’re at risk, your medical team will prepare the delivery room to manage any serious issues that arise. Delayed postpartum hemorrhage, mentioned above, is another risk.
Retained placenta can also lead to postpartum endometritis, which is inflammation or infection of your uterine lining after you give birth. The condition is different from endometriosis, a serious disease in which uterine tissue grows outside of your uterus. Endometritis is treated with antibiotics.
The good news: Retained placenta will have no effect on your baby.
What are the treatments for retained placenta?
First, your provider will try active management. When the placenta isn’t delivered within a specific window of time, they’ll attempt to move the process along by asking you to push or massaging your abdomen. They may also gently tug on your umbilical cord to loosen the placenta or administer oxytocin. Breastfeeding, peeing, or changing your position can help its delivery, as well.
Sometimes, active management doesn’t work. When it fails, your provider will try to remove the retained placenta using their hands or via surgery. The timing of the procedure depends on your clinician’s judgment.
Manual extraction is typically used first. During this procedure, a provider will try to detach the placenta from your uterine wall with their fingers. Then, they’ll pull the separated tissue out through your cervix. You’ll be given medication to manage pain and an antibiotic to prevent infection. There is a risk of hemorrhage during manual extraction, but your medical team will be prepared.
If manual extraction doesn’t succeed – meaning part or all of the placenta remains in your uterus – the next step is surgery. Suction curettage, which involves using a small vacuum to remove tissue from your uterus, is the most common procedure.
If you have placenta accreta, there’s a small risk that it’s not possible to separate your placenta and uterus. Since trying it can cause a massive hemorrhage, hysterectomy may be necessary.
This is uncommon, however, and the bottom line remains: Though retained placenta comes with serious potential health risks, it can be managed by your healthcare team – and won’t harm your baby. If you have questions or concerns about your risk of retained placenta, or how it might affect your labor and delivery (and your postpartum recovery), talk with your healthcare provider.
Read more about
Add a Comment