The placenta is a vital organ that supplies blood and nutrition to the fetus. During the third stage of labor, the body pushes it out as its work is done. However, if it doesn’t come out easily, it results in the retained placenta. This can be a serious problem that could cause life-threatening, severe infections and blood loss without prompt medical care. Keep reading as we tell you more about the causes of retained placenta, its risks factors, diagnosis, treatment, and possible complications.
What Is Retained Placenta?
Labor usually proceeds in three stages –
The first stage is when you experience the contractions which dilate your cervix to prepare for childbirth (cervical dilatation up to10cm) Second is when your baby delivers. Third is when you deliver placenta and membranes, and goes on for five to 15 minutes.
Retained placenta is a condition in which you fail to expel placenta and membranes within 30 minutes of the birth of your baby. This condition is also known as retained fetal membrane or retained cleansing. As per the US National Institute for Health and Care Excellence (NICE), the third stage is considered retained or delayed if it takes more than 30 minutes with active management, or 60 minutes with maternal effort (1). If you leave retained placenta untreated, it can lead to life-threatening complications including excessive blood loss and infection.
What Causes A Retained Placenta?
There are three main reasons for retained placenta: If the placenta is grown all over the wall of the uterus, it is known as placenta percreta. Some other rare causes include:
Retained Placenta Risk Factors
We cannot predict if any of the above cases could happen to a mother. However, certain factors increase the risk of the condition (5).
Premature labor or giving birth before the 34th week of pregnancy. Induction or augmentation of labor. Lobulated placenta. Previous cases of retained placenta. Having more than five births previously. Conceiving after the age of 35. Giving birth to a stillborn baby. Prolonged first or second stage of labor. Previous uterine surgery.
If you have any of the above risk factors, then your healthcare provider will discuss ways to manage the third stage and assist you through it.
Signs And Symptoms Of Retained Placenta
When there is retained placenta in the body, you will experience symptoms a day after your delivery. They may include:
Fever Foul smelling discharge containing large tissue residue Persistent bleeding Severe cramps and contractions
Delay in milk production
The International Board Certified Lactation Consultant (IBCLC) Renee Kam states that the placental expulsion is the signal for the breastmilk production. If placenta remains inside the uterus, this signal is interrupted, and therefore the milk supply alters.
Diagnosis Of Retained Placenta
A careful examination by your midwife or the doctor can diagnose the retained placenta. She checks if the expelled placenta is still intact with the uterus after delivery. Even a small retained portion can be a cause of worry. In a few cases, your doctor may not diagnose the missing part of the placenta. But, when you begin to experience the symptoms after delivery, it signals the retention. The diagnosis includes an ultrasound scan to check for retained placental fragments in the womb. If any part is found to be retained, you will require immediate treatment to prevent complications.
Complications Of Retained Placenta
In a standard delivery, the uterus contracts to hinder all the blood vessels inside it. But, if the placental tissue is left in the uterus, it cannot contract properly, and the blood vessels continue to bleed. If it is a managed third stage, and placenta delivery takes more than 30 minutes after the baby is out, the risk of heavy bleeding increases significantly. Excessive blood loss during the first 24 hours after delivery is called Primary Postpartum Hemorrhage (PPH) (6). If there are still small fragments left in the uterus, it can lead to heavy bleeding even after three to seven days of delivery and infections later though it occurs in just one percent of all the births (7). This condition is called Secondary Postpartum Hemorrhage.
How You Can Separate The Placenta
If your third stage of labor is taking time, you should try to breastfeed your little one or rub your nipples so that oxytocin hormone releases. It causes contractions in the uterus and helps in birthing the placenta and membranes (8). You should also try to change your position by turning upright so that gravity helps in expelling the placenta. In a physiological third stage of labor, if the placental delivery does not happen within an hour, go for managed third stage. Your doctor gives an oxytocin injection for your uterus to contract. Also, your doctor will assist in pulling out the placenta. In case the placenta doesn’t come out even after managed third stage, your doctor will give you another oxytocin injection and also inject saline into your umbilical vein to expel the placenta.
Retained Placenta Treatment
If the above doesn’t work, you may go for further treatments. Your doctor will also prescribe some oral antibiotics after any of the above treatments to prevent or treat infections.
Can You Prevent Retained Placenta?
You cannot do much to prevent retained placenta.
If you have experienced a retained placenta in a previous delivery, there is a higher risk of another one. You should inform your doctor so that she would pay close attention during the third stage of labor. Skin to skin contact with the baby could lessen the risk.
Avoid prolonged use of artificial oxytocin (syntocinon) inductions so as to reduce the risk of retained placenta, caesarean section, and uterine scar. Too much oxytocin will lead to uterine atony, which is again a leading cause for retained placenta.
