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Labor and Delivery: Retained Placenta

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What Is a Retained Placenta?

Labor occurs in three stages:

  1. The first stage is when you begin to experience the contractions that cause changes in your cervix to prepare for delivery.
  2. The second stage is when your baby is delivered.
  3. The third stage is when you deliver the placenta, the organ responsible for nourishing your baby during pregnancy.

Your body typically expels the placenta within 30 minutes of delivery. However, if the placenta or parts of the placenta remain in your womb for more than 30 minutes after childbirth, it’s considered a retained placenta.

When it’s left untreated, a retained placenta can cause life-threatening complications for the mother, including infection and excessive blood loss.

What Are the Types of Retained Placenta?

There are three types of retained placenta:

Placenta Adherens

Placenta adherens is the most common type of retained placenta. It occurs when the uterus, or womb, fails to contract enough to expel the placenta. Instead, the placenta remains loosely attached to the uterine wall.

Trapped Placenta

A trapped placenta occurs when the placenta detaches from the uterus but doesn’t leave the body. This often occurs because the cervix starts to close before the placenta is removed, causing the placenta to become trapped behind it.

Placenta Accreta

Placenta accreta causes the placenta to attach to the muscular layer of the uterine wall rather than the uterine lining. This often makes delivery more difficult and causes severe bleeding. If the bleeding can’t be stopped, blood transfusions or a hysterectomy may be required.

What Are the Signs and Symptoms of a Retained Placenta?

The most obvious sign of a retained placenta is a failure of all or part of the placenta to leave the body within an hour after delivery.

When the placenta remains in the body, women often experience symptoms the day after delivery. Symptoms of a retained placenta the day after delivery can include:

  • a fever
  • a foul-smelling discharge from the vagina that contains large pieces of tissue
  • heavy bleeding that persists
  • severe pain that persists

Who Is at Risk for a Retained Placenta?

Factors that can increase your risk of a retained placenta include:

  • being over age 30
  • giving birth before the 34thweek of pregnancy, or having a premature delivery
  • having a prolonged first or second stage of labor
  • having a stillborn baby

How Is a Retained Placenta Diagnosed?

A doctor can diagnose a retained placenta by carefully examining the expelled placenta to see if it’s still intact after delivery. The placenta has a very distinct appearance, and even a small missing portion can be cause for concern.

In some cases, however, a doctor may not notice that a small part is missing from the placenta. When this occurs, a woman will often experience symptoms soon after delivery.

If your doctor suspects you have a retained placenta, they’ll perform an ultrasound to look at the womb. If any part of the placenta is missing, you’ll need treatment right away to avoid complications.

How Is a Retained Placenta Treated?

Treatment for a retained placenta involves removing the entire placenta or any missing parts of the placenta. It can include the following methods:

  • Your doctor may be able to remove the placenta by hand, but this carries an increased risk of an infection.
  • They may also use medications either to relax the uterus or to make it contract. This can help your body get rid of the placenta.
  • In some cases, breast-feeding can also be effective because it causes your body to release hormones that make your uterus contract.
  • You doctor may also encourage you to urinate. A full bladder can sometimes prevent the delivery of the placenta.

If none of these treatments help the body expel the placenta, your doctor may need to perform emergency surgery to remove the placenta or any remaining pieces. Since surgery can lead to complications, this procedure is often done as a last resort.

What Are the Potential Complications of a Retained Placenta?

Delivering the placenta is an important step in allowing the uterus to contract and to stop more bleeding from occurring. If the placenta isn’t delivered, the blood vessels where the organ is still attached will continue to bleed. Your uterus will also be unable to close properly and prevent blood loss. This is why the risk of severe blood loss significantly increases when the placenta isn’t delivered within 30 minutes of childbirth. In many cases, excessive bleeding can be life-threatening.

What Is the Outlook for Women with a Retained Placenta?

A retained placenta is a rare complication of pregnancy that can be treated effectively once it’s diagnosed. Taking steps to correct the problem quickly can result in a favorable outcome. If you’re at risk for a retained placenta or if you have experienced a retained placenta in the past, discuss any concerns you have with your doctor before giving birth. This will allow you to be as prepared as possible for any complications.

How Can a Retained Placenta Be Prevented?

Doctors can usually prevent a retained placenta by taking steps to promote complete delivery of the placenta during the third stage of labor. These steps include the following:

  • They can give you a medication that encourages the uterus to contract and release the placenta. Oxytocin (Pitocin) is one type of medication that may be used.
  • They can apply controlled cord traction (CCT) after the placenta has separated. During CCT, your doctor clamps the baby’s umbilical cord and then pulls on the cord while applying pressure. This encourages the placenta to come out after the baby is delivered.
  • They can stabilize your uterus through touch while applying CCT.

You may notice your doctor going through these steps before you deliver the placenta. After you give childbirth, your doctor will likely recommend that you massage your uterus. This encourages contractions that help stop bleeding and allows the uterus to start returning to a smaller size.

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