A retained placenta is when the placenta does not spontaneously expel following childbirth. Small pieces of the placenta can remain inside the uterus, which can lead to hemorrhage (heavy vaginal bleeding). Symptoms may also include foul-smelling vaginal discharge, fever, chills, or weakness.
The placenta is typically expelled with uterine contractions following the birth. If contractions are not strong enough, the placenta may stay behind in the uterus. In cases of incomplete expulsion, the majority of the placenta comes out but small pieces can remain stuck to the wall of the uterus.
Treatment of a retained placenta involves removing the placental fragments, which may involve manual removal, medications and/or a surgical procedure called curettage.
Common symptoms
The main symptoms of a retained placenta include:
- Heavy vaginal bleeding (hemorrhage);
- Sticky, dark-red blood;
- Foul-smelling vaginal discharge;
- Fever (temperature >100.4 degrees Fahrenheit);
- Abdominal pain;
- Dizziness;
- Chills;
- Weakness.
It is important to seek urgent medical attention if you experience any of the above symptoms so that the condition can be identified and properly managed.
A retained placenta can also lead to endometritis (infection of the lining of the uterus). In more serious cases, bacteria can enter the bloodstream and result in a generalized, life-threatening infection.
Confirming a diagnosis
The diagnosis of a retained placenta is made by an obstetric provider. Following delivery of the placenta, the obstetric provider will examine the placenta to make sure it is intact.
If the placenta appears to be incomplete, the obstetric provider will attempt to manually remove the rest of the placenta, sometimes with the help of an instrument called a surgical forceps.
An ultrasound may be used to examine the uterus, especially if the provider suspects that there still may be pieces of the placenta remaining in the uterus. Ultrasound examination and patient symptoms can be used together to confirm the diagnosis.
Possible causes
In the majority of cases, a retained placenta results from inadequate (weak) contractions following the birth.
However, this condition can also occur if the cervix closes before the placenta is completely expelled or when the placenta is adhered (stuck) to the uterine muscles instead of the uterine lining. This is called placenta accreta.
Risk factors
Risk factors for a retained placenta include:
- Maternal age greater than 30;
- Premature birth less than 34 weeks gestation;
- A prolonged labor and delivery;
- Stillbirth.
Placental fragments can also remain in the uterus following a cesarean delivery (c-section), and even tiny pieces can lead to hemorrhage and infection.
Treatment options
Treatment of a retained placenta involves removal of the retained products by an obstetric provider. This may involve manual removal with or without the help of surgical instruments.
Medications like misoprostol or oxytocin may be used to help the uterus contract, facilitating expulsion of the placenta.
A retained placenta may require surgical intervention, in which a doctor removes the pieces of placenta under ultrasound guidance using an instrument called a curette. Antibiotics will also be administered to prevent or treat an infection.
In the case of placenta accreta, a blood transfusion or even hysterectomy (surgery to remove the uterus) may be indicated in the event of a severe hemorrhage.
Post-op instructions
Recommendations following uterine curettage include rest and avoiding placing anything in the vagina. This means not having sex and avoiding the use of tampons, douches, and menstrual cups. Make sure to confirm with your doctor when you can resume your normal activities.