Congratulations on the good news. In a few months or so, the little bundle will be snuggled in your arms.
You may be already practicing those breathing techniques for the big moment, and reading up everything there is to read about labor.
While you may be feeling ready and prepared, the time of labor can actually be quite the task, especially when you have to confront a retained placenta.
What Is Retained Placenta?
A retained placenta is a condition where the whole or a portion of the placenta and membranes are left behind in the uterus during the third stage of labor. It occurs when the placenta remains in the uterus for more than an hour after birth.
[ Read: Functions Of Placenta During Pregnancy ]
The Third Stage Of Labor:
In pregnant women, placenta is an organ that connects the developing fetus to the walls of the uterus. After the birth of the infant, the placenta and membranes are pushed out. This is referred as the third stage of labor and involves:
- The detachment of the placenta and membranes from the uterine wall.
- Contraction of uterus to close all blood vessels inside it.
- This stage usually lasts for 5 to 15 minutes.
There are two kinds of third stages of labor:
- Physiological or natural third stage
- A managed third stage.
9 Causes Of Retained Placenta:
What causes retained placenta? The main circumstances that lead to retained placenta are:
1. Uterine Atony: In this case, the uterus ceases contraction or does not contract enough to separate the placenta from the walls of the uterus.
2. Trapped Placenta: When the placenta successfully separates itself from the uterus but fails to pass through a semi closed cervix, it gets trapped behind. A trapped placenta would also happen during a controlled cord contraction in the third stage. The umbilical cord may snap if pulled too hard or is too thin, leaving the placenta inside the uterus.
3. Adherent Placenta: In rare cases, a part or the entire placenta is deeply embedded in the uterine wall and fails to detach itself from the uterus.
4. A Full Bladder: A full bladder would not allow the uterus to contract adequately, eventually preventing the placenta from being delivered. Thus the doctor would drain out the bladder by inserting a catheter.
5. ‘Fiddling’ With The Uterus: Action such as massaging or rubbing the uterus before the third stage would cause weaker, irregular contractions leading to partial separation of the placenta.
6. A Bicornuate Uterus: This is a ‘heart shaped’ uterus. A tissue, present prior pregnancy, stretches itself within the uterus giving it a heart shape. If the placenta is attached to this tissue it would not be able to disconnect itself from the uterine wall.
7. A Succenturiate Lobe: A small piece of placenta, adjoined to the main placenta by a blood vessel, left behind in the uterus is called a succenturiate lobe. This lobe would lead to a possibility of retained placenta.
8. Placenta Acreta: This is a rare but serious condition where a part of the placenta adheres to a scar on the uterine muscle instead of the lining. This commonly happens in women who have history of caesarean birth.
9. Emotional Reactions: Overwhelming emotional reactions like fear or helplessness during childbirth would trigger the release of adrenaline and cease the release of oxytocin, eventually stopping the contractions to release the placenta.
[ Read: Stages Of Childbirth ]
After Effects Of Retained Placenta:
A retained placenta would lead to postpartum hemorrhage or excessive bleeding.
- Primary Postpartum Hemorrhage: Heavy bleeding in the first 24 hours after childbirth.
- Secondary Postpartum Hemorrhage: Heavy bleeding and infection.
[ Read: Postpartum Hemorrhage ]
How Is It Treated?
Since this condition is an outcome of several causes, retained placenta treatment also varies accordingly.
1. During Third Stage:
If a physiological third stage is taking too long:
- Try breastfeeding your baby or rub your nipples. This releases the hormone oxytocin that causes the uterus to contract.
- Sit in an upright position so that gravity could help you push out the placenta and membranes.
2. During A Prolonged Third Stage:
If the third stage is taking more time, in spite of been managed:
- The doctor would inject oxytocin into your thighs for contraction.
- He would even inject saline into a vein of the umbilical cord if needed.
- He would then gently pull the placenta out.
3. Despite All Efforts:
Regardless of the above efforts, if the placenta retains in a managed third stage of labor:
- You would be given local or general anesthesia at the doctor’s discretion.
- You would be given intravenous (IV) antibiotics to avoid infection.
- The doctor would empty the bladder by inserting a catheter.
- He would then pull it out manually.
4. Bleeding Post Delivery:
If you experience excessive bleeding for days after childbirth:
- Consult your doctor immediately.
- An ultrasound of the uterus would be required.
- Fragment of placenta would be removed through ‘Evacuation of Retained Products of Conception (ERPOC).
- This procedure also includes the injection of anesthetic and antibiotics.
[ Read: Complications During Pregnancy ]
Make A Note:
- If you had a retained placenta in your previous delivery the chances of its recurrence are high. However exceptional cases have also been experienced.
- After a managed third stage and a retained placenta, a physiological third stage for your next birth could be considered.
- Retained placenta is common among premature births.
- It is also caused due to the usage of syntocinon (artificial oxytocin) to speed up the labor.
Due to its association with postpartum hemorrhage, retained placenta could be dangerous. Here are retained placenta complications:
- Manual removal of the placenta could lead to damage in the genital tract and infections.
- It could accentuate the chances of bacterial contamination in the uterine cavity.
The incidence of retained placenta is quite common in developed countries than the less developed. Some of the scenarios, like secondary postpartum hemorrhage occur in less than one per cent of births. It is good to be updated with such facts dealing with pregnancy, but do not allow it to be a source of worry or stress.
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