Retained Placenta

Having a baby can be an exciting and nerve racking experience, all at once. As soon as you find out that you are pregnant, especially for the first time, you will want to find out all there is to know about the changes that are happening to your body, as well as what is happening to that little life as it grows and develops inside you. As well as learning about all the exciting times to come, you may also want to read up a little on things that can go awry during and after the birth; this is normal and can be useful.

What is a retained placenta?

One possible complication after delivering your baby is a retained placenta. This is when some, or all, of the placenta gets left behind in your uterus (womb). After you have delivered your baby, your placenta should follow naturally around 5 to 20 minutes later, although it can take a little longer and can be speeded up with an injection. A retained placenta is usually diagnosed when it has failed to be delivered naturally an hour after birth, or 30 minutes after the injection.

How common is it?

It occurs in around 3% of natural births, but is more common with premature births. This is thought to be because the placenta is 'designed' to be in place for 40 weeks and may not release properly during premature labour and birth. You should be assured, however, that your midwife will be alert to this possibility and will be able to manage the situation.

What causes it?

There are 3 main causes of a retained placenta:

1. Uterine atony is where the uterus actually stops contracting and therefore fails to separate the placenta from the uterine wall and push it out.
2. A trapped placenta is where the placenta has come away from the uterine wall, but your cervix has closed too quickly, thereby leaving the placenta trapped inside.
3. Placenta accreta is where the placenta is so deeply embedded into the uterine wall that it fails to come away during contractions.

Your midwife will examine your placenta to ensure that it has been delivered in its entirety and is intact. They are more than likely to notice if some is missing and will take appropriate action.

What are the risks?

An untreated retained placenta can be very serious as it can cause severe haemorrhaging, or bleeding. It may only take a small amount of placenta to be left in the uterus to cause heavy bleeding and/or an infection. In undeveloped countries it can be fatal, but in developed countries, it is rare for a retained placenta to be undetected (less than 1% of births) and rarer still for it to cause death.

Following the birth of your child you can expect to have some heavy bleeding, but if this is prolonged, or starts to smell unpleasant, or you develop a temperature and begin to feel unwell, you should see your doctor or tell your midwife immediately. You may be given an ultrasound to check that no part of the placenta has remained in your uterus.

What is the treatment?

If it is taking a while for the placenta to be delivered yet you would prefer for it to occur naturally without an injection, your midwife may make a few suggestions to help it along a bit. For example, if you have chosen to breastfeed your baby, this may be a good time to try. Breastfeeding causes your uterus to contact and should help speed things along. You could also try gravity. If you are lying down, try sitting up or moving in to a more upright position to allow gravity to pull on the placenta.

If your placenta still refuses to leave the uterus, your midwife or other staff may need to intervene. An injection will be administered, but if this doesn't work, you may need to undergo a manual removal. This will be done under local anaesthetic, such as a spinal or epidural. You may also ask for a general anaesthetic if you prefer. If you undergo a manual removal of your placenta, you should expect your midwife or doctor to insert a catheter to empty your bladder. They will also place you on an IV (intravenous drip) of antibiotics to prevent infection.

How can it be avoided?

There is very little you can do to actively prevent a retained placenta but it does tend to reoccur, so if you had a retained placenta with your first child, the chances are it may happen again. Discuss your options with your midwife to make sure you are all on the same page and have an agreed plan of action.

Having a baby is a great experience and chances are that your birth will go smoothly. However, if the unexpected does happen, it is worth bearing in mind that you will be with highly trained midwives and medical staff who are trained for all eventualities and have more than likely seen it all before!