Retained Placenta.
Retained Placenta.
A mother recently at my antenatal clinic http://www.womenshealth.ie/, had a retained placenta after her last delivery and was asking why it happened, so here I am going to cover:
What is a retained placenta?
If you have a retained placenta, it means that all or part of the placenta or membranes have stayed inside your uterus (womb) after the birth of your baby. Normally, your body will expel the placenta and membranes after your baby is born, and they slide out easily through the vagina. This is called the 3rd stage of labour. For more information of the stages of labour see www.antenatalonline.ie
If your pregnancy, labour and birth have gone well, you can choose how your midwife / doctor will care for you during the 3rd stage of labour. You will be able to discuss this with them before the birth. You can opt for a physiological (natural) 3rd stage or a managed 3rd stage.
With a physiological 3rd stage the uterus naturally starts to contract after the birth. This makes the placenta detach from the wall of your uterus and helps you to push it out.
With a manged 3rd stage, your midwife gives you an injection into your thigh, just as your baby is being born. This injection helps your uterus to contract down and push out the placenta and membranes. Having a managed 3rd stage reduces the risk of heavy bleeding immediately after your baby is born.
What causes a retained placenta?
The three main causes of a retained placenta are:
When the womb stops contracting or doesn’t contract enough for the placenta to separate from the wall of the womb. This is called uterine atony or loss of tone in the uterine muscle.
When all or part of the placenta is firmly stuck to the wall of the womb. This is called an adherent placenta. In rare cases this happens because part of the placenta has deeply embedded itself in the womb. This is called placenta accrete and is more likely if the placenta embeds itself over a previous caesarean section scar. If the placenta has grown all the way through the wall of the womb it is called placenta percreta.
When the placenta comes away from the womb, but becomes trapped behind the semi-closed cervix, this is called a trapped placenta.
Occasionally it helps the placenta to come out if the midwife gives the umbilical cord a gentle pull. However, the cord may break if the placenta has not completely separated, or if the cord is thin. If this happens you may be able to help deliver the placenta by pushing with a contraction.
How is a retained placenta treated after my baby’s birth?
If you chose a physiological third stage you may find it doesn’t go as you hoped. The placenta may take longer than an hour to come out or you may have heavy bleeding. If that is the case, your midwife will offer to shorten the third stage. She will recommend an injection, which will make your womb contract, which should help your placenta detach from the wall of the uterus and come away.
After a managed third stage and if the placenta is retained your midwife may offer you another injection or she may wait another few minutes to see if it comes away on its own.
Your midwife will then check by feeling your abdomen, if the placenta has detached from your womb and if it has she will pull gently on the cord to encourage the placenta to come out.
You will be under close observation by your midwife, because if the manged delivery of the placenta takes longer than 30 minutes you are at risk of bleeding. This is called a postpartum haemorrhage (PPH).
If the third stage is taking longer than normal your midwife may recommend that you have a syntocinon drip in your arm in case of a PPH. This is nothing to worry about and is usually only a precaution.
If you have physiological third stage your placenta should be delivered within an hour
If you have managed third stage your placenta should be delivered within 30 mins
You can also be treated for retained placenta if part of the placenta comes away and part stays within the womb.
If the placenta still has not come away after treatment, your doctor may need to remove it by hand but you will usually have an epidural or spinal or general anaesthetic for this procedure. This procedure is usually carried out in theatre.
What are the symptoms of retained placenta?
If a small piece of placenta is left inside your womb, it very often passes through the vagina by itself. You may notice tummy cramps before passing a clot. This could be the piece of placenta left behind. If you are at home and this happens contact your midwife / maternity unit. She may want to check out the amount of bleeding and check is your womb has contracted.
Sometimes the small pieces of retained placenta don’t come away and you can develop symptoms such as:
Heavy bleeding
Fever
Discharge smell
Tummy cramps
Again contact your midwife, maternity unit or doctor. You may be referred for an ultrasound to check for pieces of placenta or membrane in the womb.
If pieces of retained placenta remain depending on the size of them and your symptoms you may need a procedure called evacuation of retained products of conception (ERPC). This procedure is carried out under epidural, spinal or general anaesthetic in theatre. You may be prescribed antibiotics to protect you and treat any infection.
Bleeding and cramping are normal after having a baby, but if you are worried please call your midwife or doctor for advice.
Can I prevent a retained placenta in my next pregnancy?
Unfortunately, there isn’t much you can do to prevent it. You are at higher risk of having a retained placenta if you experienced it in an earlier pregnancy. That does not mean you will definitely have one.
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