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The truth is that labour can be unpredictable, often starting and stopping intermittently, and it's not uncommon for a complication to occur. A retained placenta is a rare pregnancy problem, but it's important to be aware of it. The good news is that a retained placenta can be easily treated and will not harm your baby.
What Is A Retained Placenta?
A retained placenta is an uncommon problem that affects only 2 to 3% of all deliveries. It occurs when all or part of the placenta remains inside the uterus after the baby is born.During pregnancy, the placenta attaches to the uterine lining, allowing nutrients, oxygen, carbon dioxide, and water from the mother's blood to be transferred to the baby, with carbon dioxide from the baby cycling back to the mother via the umbilical cord and placenta for removal.The placenta is divided into parts, each connected to the umbilical cord with vessels and a double-layered membrane that forms a see-through sac surrounding the foetus.The final (or third) stage of labour after birth is the delivery of the placenta during uterine contractions. The placenta is normally delivered between 5 to 30 minutes after a vaginal delivery and promptly following a C-section.However, part or all of the placenta may be retained inside the womb because it has grown through the uterine muscle or gets "caught" inside the uterus when it is compressed. A retained placenta occurs when the placenta is not delivered intact or if it is not expelled within 30 to 60 minutes of birth.Process of Delivering Placenta
The delivery of the placenta is known as the third stage of labour.If you undergo a caesarean section, your medical team will deliver the placenta after your baby is born.If you give birth vaginally, you have two options for delivering the placenta.- Active management involves injecting a medication called oxytocin into your thigh to compress your womb and help the placenta exit more rapidly.
- Physiological management occurs when you deliver the placenta after birth without receiving medication.
Cause of a Retained Placenta
There are three types of retained placenta, each with a unique reason. They include:- Placenta adhesion occurs when the uterine muscles do not contract sufficiently to detach the placenta from the uterine wall and discharge it from the womb.
- A trapped placenta occurs when the placenta separates from the uterus but does not exit the mother's body. This can happen when the cervix starts to close before the complete placenta is removed.
- Placenta accreta occurs when the placenta develops into the deeper layers of the uterus and is unable to detach spontaneously. This is the most deadly type of retained placenta, requiring a hysterectomy and blood transfusions.
Who Is At Risk For Having A Retained Placenta?
Women at risk of having a retained placenta include those who have:- A previous C-section
- Previous dilation and curettage (D&C)
- A previous procedure for uterine fibroid excision
- Premature birth (before 34 weeks), stillbirth, or uterine anomalies
- Possible pregnancy complications include a prolonged first or second stage of labour and a retained placenta from a prior birth
- Some pregnancy issues, such as placental abruption or velamentous cord insertion
Symptoms of Retained Placenta
The most typical indication of a retained placenta is when the organ that feeds your baby throughout pregnancy fails to deliver spontaneously within 30 to 60 minutes of birth.If fragments of the placenta are remaining inside your body days or weeks after birth, you may have the following symptoms:- Fever
- Consistent heavy bleeding with blood clots
- Cramping and Pain
- A foul-smelling discharge
Complications of Retained Placenta
A retained placenta occurs after birth, thus there are no consequences for the baby. However, new mothers may face risks.Excessive bleeding, also known as postpartum haemorrhage, can occur between the delivery of the baby and the delivery of the placenta, resulting in severe blood loss and even placing the mother at risk of requiring a blood transfusion and other emergency procedures. Physicians are trained to take specific steps to discover why a mother is bleeding excessively and to manage the haemorrhage as quickly as possible.On a smaller scale, if the pieces of the retained placenta are very small and there is no abnormal bleeding on the spot, it may result in postpartum bleeding that lasts longer than expected, excessive bleeding that begins 10 to 12 days after delivery, or abnormal cramping and pain two to three weeks later.By 14 days after birth, a placental scab forms, and you may notice an increase in bleeding as the placenta scab peels off, which may go unnoticed because the uterus is already shrinking. However, if there is an infection or a small bit of the placenta that remains, new bleeding of bright red blood might begin and grow heavy, necessitating an emergency room appointment or a doctor's visit.Treatment of Retained Placenta
The placenta or any sections of it that have remained inside the womb must be removed during treatment. This residual component can be removed immediately after birth, either manually or with an instrument.If it's been a week or two, depending on how much tissue is shown on an ultrasound, your doctor will most likely recommend a cervical exam, a D&C, or medications like misoprostol with antibiotics (or a combination of these).Can A Retained Placenta Be Avoided?
Dr. Rani Koppula, DGO at MS General Surgery, Gleneagles Hospitals, suggests that the following techniques can help prevent retained placenta:- Uterine massage
- Medications like oxytocin
- Controlled cord traction (putting pressure on the lower abdomen while pulling on the umbilical cord) may be used, but this is not recommended for velamentous cord insertion.
Can You Get a Retained Placenta Again?
If you had a retained placenta in one pregnancy, research suggests that you may have a 6 to 13% probability of experiencing it again in a subsequent pregnancy. Simply ensure that your doctor is aware of all aspects of your pregnancy history and that your labour and delivery team connects with you to design the best birth plan possible.Remember that all of these eventualities are extremely unlikely to occur during labour and delivery of your baby. In the unusual event that you have a retained placenta, your medical team will know what to do to reduce the dangers and help you begin your parenting journey securely.FAQs on What Does It Mean to Have a Retained Placenta?
- Is a retained placenta life-threatening?If a retained placenta is not recognised and treated, it might result in a severe haemorrhage, known as primary postpartum haemorrhage (PPH). If left untreated, this can be fatal. Although this may sound alarming, your midwife or doctor will be prepared to treat PPH in whatever environment you give delivery.
- Can you have another baby after a retained placenta?After having had a retained placenta, your odds of having another one increase. However, you can have a good pregnancy without developing any issues.