Retained placenta

Many women do not realize that the birth of a child does not complete the birth process. In fact, the last stage of labor in a pregnant woman occurs when her placenta comes out of the uterus. For many women, this process happens on its own after the baby leaves the birth canal, but for some, this process does not happen automatically, resulting in a phenomenon called retained placenta.

What is retained placenta?

As the name suggests, placental retention occurs when the placenta remains in the uterus and does not come out on its own naturally. When this happens, the process must be manipulated so that the placenta can be removed from the woman's uterus.

If the placenta remains inside a woman's uterus, the consequences can be life-threatening, leading to infection and even death.

The work takes place in three stages:

The first stage of labor begins with contractions that indicate that the uterus is preparing for childbirth.
Once a woman has given birth, the second stage of labor is completed.
The last stage of labor is when the placenta is expelled from the woman's uterus. This stage usually occurs within 30 minutes after the baby is born.

However, if a woman has not expelled the placenta 30 minutes after giving birth, it is considered a retained placenta because the woman's body has retained the placenta rather than expelled it.

If retained placenta is not treated, the mother is susceptible to both infection and severe blood loss, which can be life-threatening.

If your pregnancy went through the stages of labor and delivery normally, you can choose how to behave in the last stage of labor. This process is usually part of the discussion about the woman's birth plan.

Generally, there are two approaches used when dealing with the placenta: natural or controlled.

The natural approach allows the female body to expel the placenta naturally on its own.

The medical staff assist in a guided approach and usually occurs when an injection is made into the thigh during the birth of a baby, causing the woman to expel the placenta.

Synthometrine, ergometrine, and oxytocin are drugs that cause the female body to contract and expel the placenta. If a woman had complications such as high blood pressure or preeclampsia during pregnancy, Syntocinon is prescribed.

The advantage of choosing a controlled end stage of labor is to reduce bleeding immediately after the baby is born.

What causes retained placenta?

The following are common circumstances that lead to retained placenta:

When the placenta germinates through the wall of the uterus, the placenta germinates.
Uterine atony occurs when a woman's contractions stop or are not strong enough to expel the placenta from the uterus.
Placenta adhesion occurs when all or part of the placenta adheres to the wall of a woman's uterus. In rare cases, this is due to the fact that the placenta has sunk deep into the uterus.
Placenta accreta occurs when the placenta descends deep into the uterus, possibly due to a scar from a previous caesarean section.
Placental entrapment occurs when the placenta separates from the uterus but does not come out. Instead, it becomes trapped behind a closed or partially closed cervix.
In rare cases, a doctor can help prevent retained placenta by gently pulling on the umbilical cord. However, the umbilical cord may rupture if the placenta has not completely separated from the walls of the uterus or if the umbilical cord is thin.

If this happens, delivery of the placenta may occur with contraction to push it out.

What are the signs and symptoms of retained placenta?

When the placenta cannot be completely separated from the uterus one hour after delivery, this is the most obvious sign of retained placenta.

A woman may experience symptoms such as:

fever
a foul-smelling discharge from the vaginal area
large pieces of tissue coming from the placenta
heavy bleeding
pain that doesn’t stop

Who is at risk for retained placenta?

Certain factors increase a woman's chance of retaining her placenta.

They include:

A pregnancy that occurs in women over the age of 30
Having a premature delivery that takes place before the 34th week of gestation
Experiencing an extremely long first and second stage of labor
Delivering a stillborn baby

How to treat retained placenta?

The treatment for retained placenta is to simply remove the placenta from the woman's uterus.

Various methods are often used to do this, including:

The doctor may try to remove the placenta manually. However, this carries a certain risk of infection.
Medicines that relax the uterus and cause it to contract can also be used to push the placenta out of the uterus.
Breastfeeding may be used in some situations, as this process causes the uterus to contract and this may be enough to push the uterus out of the uterus.
Sometimes something as simple as urination is quite effective in expelling the placenta, as a full bladder can sometimes prevent the placenta from expelling from the uterus.

Unfortunately, if none of these methods help remove the placenta from the uterus, emergency surgery may be required as a last resort. This is usually kept as the last approach due to the complications the surgery can create.

What are the potential complications of retained placenta?

The risk of heavy bleeding is increased. This condition is called primary postpartum hemorrhage. When controlled delivery of the placenta takes more than 30 minutes, heavy bleeding often occurs.
You have the option to request general anesthesia, but you risk more, especially if you want to breastfeed immediately after the procedure.
Traces of the drug will still be in your body, which means the drug will also be in your breast milk. You also need to make sure that you are alert enough to hold and support your baby firmly while breastfeeding.
However, if you choose anesthesia, the placenta and any other remaining membranes will be manually removed from your uterus while your legs are in the stirrups in the lithotomy position.

After the procedure, you will be given intravenous antibiotics to avoid the risk of infection. Additional medicines will be given to help your uterus contract afterwards.

What is the outlook for women with retained placenta?

A retained placenta can be treated. Time is everything. The sooner steps are taken to fix the problem, the better the outcome will be.

If you are at high risk of having a retained placenta or have experienced it in the past, talk to your doctor before having another baby. Your doctor will help you prepare for possible complications.

Can I prevent retained placenta in my next pregnancy?

While you can't prevent placental retention from happening again, that doesn't mean your next birth will have the same outcome. Although your chances of retaining the placenta increase again after having it before, you can still have a healthy pregnancy that doesn't cause this type of complication.

If your baby was born premature, the risks also increase. The placenta must remain in place for 40 weeks. As a result, preterm labor can lead to retained placenta.

Doctors do everything in their power to prevent a retained placenta by taking steps to speed up the complete passage of the placenta after the baby is born.

These steps are as follows:

Medication that encourages contractions in the uterus to help push out the placenta. Oxytocin is an example of a medication that might be used
Control cord traction after the placenta has released
Stabilizing your uterus by applying control cord traction through touch manual touch

These are all the standard steps your doctor can take before delivering the placenta. After giving birth, your doctor will also recommend that you massage your uterus to stimulate contractions that stop bleeding and allow your uterus to return to a small size.

In the unfortunate event that your umbilical cord ruptures or your cervix closes too quickly after an oxytocin injection, consider a physiological third stage if you get pregnant again.

If you allow the placenta to come out naturally, the cervix is more likely to close at the right time, rather than close too quickly. Discuss your options with your doctor.

However, be aware that long-term use of synthocinone (artificial oxytocin) during labor has contributed to retained placenta.