Retained Placenta - Causes & Treatments

What Is Retained Placenta?

The placenta is a pancake-shaped organ which actually enables a pregnant woman’s body to feed the fetus with the required nutrients and proteins during the course of a pregnancy. However, once the job is done, this organ needs to be pushed out of the body which usually happens during the critical third stage of labor. However, at times, the placenta or parts of it gets stuck and doesn’t get expelled easily. This resultant condition is called retained placenta can lead to several life-threatening complications if steps are not taken in the right direction to remedy this condition immediately. As a matter of fact, a retained placenta, with its associated hemorrhaging, is said to be a leading cause of maternal mortality. This condition is also known as retained cleansing or retained fetal membrane.

If the retained placenta if left untreated or if parts of it remain in the womb, the mother can experience a host of symptoms including excessive blood loss (post-partum hemorrhage), infection, cramps in the stomach, smelly vaginal discharge, high-fever as well as an inability to produce breast milk. There have also been rare cases where the retained placenta remains unnoticed until the emergence of other symptoms.  In case of these symptoms, the consulting physician may refer the individual for a diagnostic imaging test such as an ultrasound scan to check for the presence of fragments of placenta or membrane in the womb. Thereon, a surgery is usually required to remedy this situation which requires to happen within a few hours after birth in order to prevent bleeding. Usually, doctors prescribe a dose of antibiotics to avoid infection.

What Causes a Retained Placenta?

Doctors only acknowledge a patient to have a retained placenta condition if the placenta or it’s fragments have failed to separate from the womb. In order for the womb to contract in an appropriate fashion, it must be completely empty. There are three primary reasons for retained placenta:

Uterine Atony: Regarded as the most common type of retained placenta, this is a condition where the uterus suffers from weak or insufficient uterine contractions. What this means is that the womb simply does not contract enough or stops contracting which entails that the placenta is incapable of detaching itself from the uterine wall and getting expelled by itself.

Trapped Placenta: Trapped placenta is a condition wherein a portion of the placenta remains in the uterus but gets trapped behind a closed cervix. This usually occurs when the cervix begins to close before the placenta completely detaches from the uterus.

Placenta Adherens: When the entirety of the placenta or small parts of the placenta finds itself properly attached to the uterine wall, this condition is identified as placental adherens. At times, it might so happen that an area of the placenta can not only get deeply embedded but also find itself firmly attached into the wall of the uterus as well – this is called as placenta accreta. The likelihood of this condition increases in case there is a previous C-section scar which allows the placenta to embed itself. If the placenta attaches itself and grows all over the wall of the uterus – at times even extending itself to adjacent organs such as the bladder – it is recognized as placenta percreta.

Succenturiate Lobe: In some cases, retained placenta can also occur when a small part of the placenta finds itself linked to the main part through a blood vessel – described as a succenturiate lobe – that is left behind in the uterus.

In all the above-mentioned conditions, the placenta doesn’t completely detach itself from the uterus after a patient gives birth which can lead to dangerous bleeding. Studies have revealed that the occurrence of these conditions is about 1 in 530 births annually.

Retained Placenta Risk Factors:

Although it’s difficult to predict what causes a retained placenta in a patient, there are certain factors which can increase the risk of contracting the condition. However, having said that, it doesn’t mean it will definitely happen.

• Previous scar from a surgery – such as after removing a fibroid or having a c-section.
• Early onset of labor – before the 34th week of pregnancy.
• Smoking.
• Pregnancy-associated with hypertension.
• Previous instances of uterine surgery.
• Inducted labor or augmentation of labor.
• Abnormalities in the placenta such as a Lobulated placenta.
• Previous cases of retained placenta.
• Grand Parity – Having more than five previous births.
• Conceiving after the age of 35.
• Giving birth to a stillborn baby.
• A prolonged first or second stage of labor.

As mentioned before, a person is more likely to have a chance of getting a retained placenta if these conditions exist. Additionally, depending on the number of more c-sections a patient has had previously, the more likely it is that the individual is susceptible to having these placental problems.

Retained Placenta Treatment:

There are several treatments options available as detailed below:

Controlled cord traction: In cases where the placenta is unable to get released despite being disconnected from the uterus, a controlled cord traction treatment is recommended. Under this treatment, in order to expel the placenta and ease it out, the surgeon will slowly pull out the umbilical cord.

Curettage: Curettage is described as a process where the placental debris is expelled from the uterus through scrapping using a curette under proper medication.

Hysterectomy: Also known as a procedure where the uterus is surgically removed, this is recommended in cases of placenta percreta where the placenta is deeply embedded in the uterus. However, the biggest disadvantage of getting a hysterectomy done is that an individual wouldn’t be able to carry any future pregnancies.

Manual removal of placenta: If the placenta is unable to get expelled with the help of surgical methods, it will require to be removed manually by a doctor, usually in either in a delivery room or operation theatre. After administering the patient with a local anesthesia – either spinal or epidural – the surgeon will manually try to extract the placenta by placing a hand inside the uterus.