There’s a lot to wonder about when it comes to pregnancy—the body really does do some amazing things. As just one example, it creates an entirely new one organ specifically to help the baby develop: the placenta.
The placenta plays an important role in pregnancy, but once you deliver the baby the special organ has served its purpose and is no longer needed. In a vaginal birth, the body deliver the placenta after the baby comes out; during a c-section, the doctor Removing the placenta. In some cases, however, delivery of the placenta does not go as planned and the placenta remains in the uterus, resulting in a complication known as a retained placenta.
Here’s what you should know about this complication, including symptoms and signs of a retained placenta, risk factors, treatment options and more.
What is Retained Placenta?
Retained placenta is when the entire placenta or a part of it remains inside the uterus after delivery, explains Jennifer Gilner, MD, PhD, an assistant professor of obstetrics and gynecology at Duke University School of Medicine. This complication occurs in up to 3 percent of deliveries. When only parts of the placenta remain in the uterus, it is sometimes referred to as fragments of the placenta remain.
“Usually the placenta will spontaneously separate from the lining of the uterus shortly after the baby is delivered, triggered by strong uterine muscle contractions,” says Gilner. For a vaginal delivery, this usually happens within 30 to 60 minutes, he added.
Delivery of the placenta is actually considered its own stage of labor, he added Gabriela Dellapiana, MD, a maternal-fetal medicine specialist at Cedars-Sinai in Los Angeles. “Making and delivering is divided into three stages,” he explained. Stage 1: dilation of the cervix; stage 2: the stage of pushing the delivery of the baby; and stage 3: delivery of the placenta. The placenta is highlighted as having its own stage because not removing the placenta in its entirety, or in a timely manner, increases the risk for heavy vaginal bleeding during the postpartum period.”
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Types of Retained Placenta
There are three types of retained placenta, according to American Pregnancy Association (APA):
- The placenta is attachedthe most common type of retained placenta, occurs when uterine contractions are not strong enough to expel the placenta, so it remains attached to the uterus.
- Trapped placenta is when the placenta separates from the uterine wall, but remains in the uterus, usually because the cervix closes before it can be removed.
- Placenta accreta is a condition in which “the growing pregnancy arrives at or near a previous scar or abnormal lining of the uterus—usually from a previous cesarean, although it can be from other gynecologic procedures. Then, as the pregnancy grows , the placenta forms an abnormal attachment to the uterus that cannot be released after delivery,” Gilner said. The APA says this poses a serious risk of severe bleeding and may require blood transfusions and/or hysterectomy.
Causes and Risk Factors of Retained Placenta
We know that placental delivery is important to the health and safety of a birthing parent—so what causes a retained placenta in the first place?
Causes
According to Dellapiana and Gilner, possible causes of retained placenta include:
- The placenta is abnormally attached to the uterine wall (as discussed above)
- Insufficient contraction of the uterus after childbirth
- The cervix begins to close before the placenta is delivered
- Abnormal shape of the placenta
- The umbilical cord is detached from the placenta prematurely
- Abnormal shape of the uterine cavity
Risk factors
Some risk factors that can result in a retained placenta are:
- Preterm delivery
- Previously retained placenta
- Congenital uterine anomalies
- Previous termination of pregnancy, miscarriage or curettage (removal of tissue from the uterus)
- History of more than five previous deliveries
“Certain conditions can increase the likelihood of having a retained placenta, such as umbilical cord abnormalities, a placenta with multiple separate lobes… [and] before uterine surgery, such as a cesarean delivery or fibroid removal,” Dellapiana added.
Symptoms and Signs of Retained Placenta
The main symptom of a retained placenta is heavy postpartum bleeding, also called postpartum hemorrhage, Dellapiana says. This usually happens within 24 hours of delivery, but can sometimes be delayed up to 12 weeks. That’s why it’s important to monitor yourself for excessive vaginal bleeding, which Dellapiana defines as “saturating more than four maxi pads in two hours and/or passing large blood clots.” Postpartum patients with retained placenta may also experience fever, uterine tenderness or painful cramping.
There is also a risk of infection. “In cases where retained placental tissue is not immediately visible and remains in the uterus for several days or more, intrauterine infection can develop,” Gilner added.
How Long Can You Have a Retained Placenta?
If the placenta, whole or partial, remains in the uterus beyond 30 to 60 minutes after delivery, it is considered retained. The condition persists until all pieces of the placenta are removed, Dellapiana and Gilner said.
Retained Placenta Treatment Options
How a provider treats a retained placenta depends on a variety of factors, such as when the condition was caught and its severity. Here are some possible treatment options, according to Dellapiana:
- Medicines that cause the uterus to contract to allow you to push the placenta out, or for the provider to manually remove it
- Surgical procedures such as “curette excision, or cleaning procedure, to gently scrape the placenta from the uterine wall with or without vacuum suction”
- If the retained placenta is diagnosed later in the postpartum period, a hysteroscopywhich uses a small camera and instruments to look inside the uterus and clean it, may be needed.
- In rare instances where the placenta is pathologically adhered to the uterine wall and cannot be physically separated, a hysterectomy may be necessary to stop potentially fatal bleeding.
Can You Prevent This Complication?
Unfortunately, there is no way to completely prevent a retained placenta. However, providers will look for early identifications during pregnancy if possible and take steps during labor to provide the best care to avoid this complication.
“The ‘gold standard’ in obstetric care to prevent retained placenta is to ‘actively manage’ placental delivery by actively giving Pitocin after the baby is born … as well as massaging the uterus or applying fluid which is gentle traction on the umbilical cord,” says Gilner. “It’s also important for the birth attendant to inspect the placenta after it comes out to make sure the tissue is complete.”
Although an retained placenta can be a serious complication, your provider is trained to address and treat it as soon as possible if you experience it. If you’re pregnant and concerned about having a retained placenta or if you’re postpartum and concerned about how heavy your bleeding is, contact your provider to discuss this (and hopefully put your mind at ease ).
Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult a qualified physician or health professional regarding your specific circumstances.
Plus, more from The Bump:
What Does the Placenta Do?
What You Need to Know About Preeclampsia
Everything You Need to Know About Postpartum Recovery After a Vaginal Birth
