Definition

Retained placenta is a condition where part or all of the placenta remains attached to the uterine tissue for more than 30-60 minutes after the baby is born. Normally, after delivery, the uterus contracts to help expel the placenta from the mother's womb through the vagina. Post-delivery, the placenta usually comes out within 5–30 minutes.

The placenta attaches to the uterus during pregnancy. It serves many functions for the fetus, such as providing nutrients, oxygen, and water from the mother to the fetus. Additionally, carbon dioxide from the fetus is transferred back to the mother through the placenta to be excreted from both the fetus and the mother's body. Therefore, the placenta plays a very important role in the survival of the fetus.

However, after birth, the baby no longer needs the placenta to meet its nutritional and oxygen needs. Therefore, the placenta must be expelled from the mother's body. If the placenta remains in the uterus, it can cause health problems that can threaten the mother's life.

Retained placenta occurs in about 1-3% of all births. This condition is one of the most common causes of pregnancy and childbirth-related diseases in mothers. If the placenta attached to the uterus is forcibly pulled, it can cause postpartum bleeding and the uterus to prolapse. Therefore, retained placenta can be dangerous for mothers if not treated properly.

Uterine inversion is a condition in which the uterus protrudes from the genitals, as described here: Continuous Inversion - Definition, Cause And Risk Factor.

Causes

Several conditions can cause retained placenta in mothers during childbirth:

• The uterus does not contract after the baby is born. This can happen due to weak uterine muscle contractions, causing the placenta to remain attached to the uterine wall.
• The placenta has detached from the uterus but is trapped in the partially closed cervix. This causes the placenta to remain trapped and stay in the uterus.
• The placenta attaches deeply into the uterine muscle, making it difficult to detach from the muscle. This can lead to severe bleeding.

Risk Factor

Several factors can increase the risk of retained placenta, including:

• History of cesarean delivery
• Premature delivery with a gestational age of less than 34 weeks
• Stillbirth
• Uterine abnormalities
• Labor that is too long or too fast
• History of retained placenta
• Prolonged use of uterine contraction-inducing drugs, such as oxytocin
• History of uterine surgery
• Giving birth more than 2-3 times
• Pregnancy through in vitro fertilization
• Twin pregnancy
• Mother’s age over 30 years

Symptoms

When the baby is born but the placenta does not spontaneously come out of the uterus after 60 minutes, this is considered retained placenta. Additionally, the mother may experience heavy bleeding.

If part of the placenta tissue remains in the uterus for several days to weeks, the mother can experience symptoms such as:

• Fever
• Persistent bleeding with blood clots
• Abdominal pain and cramps
• Foul-smelling vaginal discharge
• Chills
• Large tissue is protruding from the vagina

Diagnosis

To diagnose retained placenta, the doctor will observe the symptoms experienced by the patient after childbirth. The diagnosis is based on whether the placenta is expelled within 30-60 minutes after the baby is born. If the placenta does not come out within this time, the doctor can diagnose retained placenta.

Additionally, the doctor will measure blood pressure and pulse rate. A physical examination of the abdomen will be performed to check the size of the uterus and uterine contractions and to observe the amount of blood coming from the vagina. In cases of retained placenta, the blood flow is usually very heavy and continuous.

Supporting examinations like abdominal ultrasound (USG) can also be done to support the diagnosis of retained placenta and to determine the location of the placenta in the uterus.

Management

After the baby is born, healthcare professionals will try to expel the placenta slowly with the help of uterine contractions. If the placenta has not come out of the uterus within 60 minutes, the doctor will perform the following procedures:

• Injecting drugs that induce uterine contractions, such as oxytocin. Uterine contractions can help detach the placenta from the uterine lining.
• Massaging the abdomen to stimulate uterine contractions. This procedure can cause discomfort.
• Breastfeeding, as it is known that breastfeeding the baby immediately after birth can help the uterus contract. This can cause the placenta to come out naturally and prevent retained placenta.
• Changing position by rolling to the side or squatting can also induce uterine contractions and push the placenta out of the uterus.

If the placenta does not come out within 30 minutes after the above procedures, the doctor can manually remove the placenta using their hand. Due to the pain this can cause, the patient will be given local anesthesia to reduce pain. Since this procedure also increases the risk of infection, antibiotics may be administered before the procedure. However, further research is needed to determine the benefits of administering antibiotics before the procedure.

The patient's vital signs, such as blood pressure, pulse, breathing, and temperature, will be monitored by medical staff. If the patient's blood pressure drops to the point of shock, fluid and oxygen therapy will be provided as needed.

If the placenta does not detach from the uterine wall through these steps, surgery may be performed to remove the placenta from the uterus. If the placenta is deeply embedded or extends to other tissues, a hysterectomy may be necessary to prevent severe bleeding and save the patient's life.

Complications

Untreated retained placenta can cause several health complications, such as:

• Severe and continuous bleeding can lead to significant blood loss and shock, a condition where the body's organs do not receive enough blood and oxygen for tissue needs
• Increased risk of infection, such as endometritis (infection/inflammation of the uterine tissue)

Prevention

Several studies mention techniques that can help prevent retained placenta, including:

• Uterine massage
• Controlled cord traction is a method performed by medical personnel by pressing the lower abdomen while simultaneously pulling the umbilical cord gently downward

When to See a Doctor?

Generally, since this condition occurs in healthcare facilities, the doctor assisting with the delivery will recognize if you have retained placenta. If you do not give birth in a healthcare facility, you should go to the nearest emergency room (ER) to receive proper care from a doctor.

Looking for more information about other diseases? Click here!