A retained placenta occurs when the placenta fails to detach from the uterine wall after childbirth. This condition affects around 1-2% of all deliveries and can lead to significant blood loss and other complications if not managed properly. In rare cases, a retained placenta that is not treated in time can even lead to maternal death.
What is a retained placenta?
The placenta is a temporary organ that develops during pregnancy to provide oxygen and nutrients to the growing baby as well as remove waste products from the baby’s blood. During normal delivery, the placenta detaches from the uterine wall shortly after the baby is born and is expelled from the uterus as the afterbirth.
A retained placenta occurs when all or part of the placenta remains attached to the uterus longer than typical. Normally, delivery of the placenta occurs within 30 minutes of birth. If it takes longer than 30 minutes, it is considered a retained placenta.
Some key facts about retained placenta:
- Occurs in around 1-2% of all births
- More common in vaginal deliveries than C-sections
- Risk increases with maternal age over 35
- Previous retained placenta increases risk
- Multiple gestation (twins, triplets) increases risk
Causes
There are several factors that can contribute to a retained placenta:
- Uterine atony – The uterus fails to contract adequately after birth which can prevent the placenta from properly detaching.
- Abnormal placenta adherence – The placenta implants too deeply into the uterine wall making separation more difficult.
- Prior uterine surgery – Scarring from procedures like cesarean section or fibroid removal can prevent proper placental detachment.
- Prior uterine infection – Infections like chorioamnionitis can cause inflammation that inhibits placental separation.
- Overdistended uterus – As with multiple gestations, an overstretched uterus may not contract efficiently.
- Rapid labor – Very rapid deliveries can cause retention by not allowing enough time for placental separation.
Symptoms
The main symptom of retained placenta is failure to deliver the placenta within 30 minutes after giving birth. Other signs and symptoms may include:
- Excessive bleeding after delivery of the baby
- Uterine cramps
- Lower abdominal pain
- Feeling dizzy or weak from blood loss
- Signs of infection like fever, chills, foul-smelling discharge
Diagnosis
If a woman has not delivered her placenta within 30 minutes of giving birth, her doctor will normally examine her to determine if it is a retained placenta. Diagnostic tests may include:
- Physical exam of the abdomen to feel if the uterus is enlarged
- Pelvic exam to see if the placenta is still present in the cervix or vagina
- Ultrasound to identify placental tissue still attached to the uterus
- Blood tests to check for anemia and infection
Risks and Complications
Some potential risks and complications of retained placenta include:
- Hemorrhage – Excessive bleeding is the most serious risk of retained placenta and the leading cause of maternal death from this condition. Without the placenta separating properly, the uterine blood vessels are left exposed which can lead to severe blood loss.
- Infection – Retained tissue increases the risk of developing endometritis, sepsis, or other infections of the reproductive tract.
- Uterine rupture – Forcibly trying to remove an adherent placenta can lead to perforation or rupture of the uterine wall.
- Hysterectomy – In rare cases, emergency hysterectomy may be needed to control severe bleeding that cannot be stopped otherwise.
- Blood transfusion – Significant blood loss often requires transfusion to replace blood volume and treat anemia.
- ICU admission – Severe bleeding may lead to hemodynamic instability requiring intensive monitoring and treatment.
Management and Treatment
If the placenta is not expelled spontaneously within 30 minutes of delivery, active management is recommended. Treatment options may include:
- Uterine massage – Rubbing the abdomen and encouraging the mother to breastfeed can stimulate uterine contractions to expel the placenta.
- Medications – Oxytocin and other uterotonics are often given via IV to induce uterine contractions.
- Controlled cord traction – Gentle, sustained pulling on the umbilical cord while the uterus contracts can help deliver the placenta.
- Manual removal – If the placenta does not deliver with the above measures, the doctor may reach into the uterus and gently detach and remove it.
- Surgery – Rarely, operative procedures like dilatation and curettage or hysterectomy may be needed for severe cases.
It is critical to monitor the woman for bleeding and promptly treat any hemorrhage or shock during and after treatment. Blood transfusions and IV fluids may be given as needed. Antibiotics are also commonly prescribed to prevent infection.
Can retained placenta cause death?
Yes, in rare cases, retained placenta can lead to maternal death. The vast majority of retained placenta cases are managed successfully with proper treatment. However, if severe bleeding occurs and emergency care is delayed, a retained placenta can potentially be fatal.
Some key points:
- Excessive blood loss is the most dangerous complication of retained placenta.
- Hemorrhage leads to hypovolemic shock if not treated urgently.
- Maternal mortality is highest in low-resource settings where emergency care is not readily accessible.
- Deaths from retained placenta are very rare in high-income countries due to access to medications, blood transfusions, surgery, and ICU care.
While any postpartum hemorrhage can lead to death without prompt treatment, retained placenta carries a higher risk of severe bleeding and increased mortality compared to other causes. However, statistics show that in developed countries, less than 1 in 100,000 births result in maternal death from retained placenta.
Prevention
While some risk factors for retained placenta cannot be avoided, some things that may help reduce the risk include:
- Allowing the placenta to deliver spontaneously without unnecessary traction on the cord
- Avoiding forceful cord traction before placental separation occurs
- Waiting for signs of placental separation before attempting removal
- Active management of third stage of labor with uterotonic medications
- Timely treatment of any infections during pregnancy
- Controlling chronic conditions like hypertension and diabetes
Providing access to skilled birth attendants and emergency obstetric care is vital for preventing maternal deaths should a retained placenta occur.
Conclusion
In summary, retained placenta is an uncommon but potentially serious complication following childbirth. The most dangerous consequence is excessive bleeding leading to hemorrhagic shock, which very rarely can be fatal without emergency treatment. However, with proper active management, the vast majority of retained placenta cases are treated successfully. Access to quality maternity care drastically reduces the risks associated with this condition.
