What Is A Retained Placenta?
What Is A Retained Placenta?
What Is A Retained Placenta?
Approved by the BabyCentre Medical Advisory Board Last reviewed: October 2012 Show references
Highlights
What is a retained placenta? What causes a retained placenta? What problems can a retained placenta cause? What happens if my third stage is taking too long? How is a retained placenta treated? Can I prevent a retained placenta in my next pregnancy?
Within one hour of your baby's birth if you had a physiological third stage (about 13 per cent of cases). Within 30 minutes of your baby's birth if you had a managed third stage (less than five per cent of cases).
When the uterus stops contracting, or doesn't contract enough for the placenta to separate from the wall of your uterus. This is called uterine atony. When part or all of the placenta is stuck to the wall of your uterus and doesn't separate. This is called an adherent placenta. In rare cases this happens because the placenta has deeply embedded itself in the wall of your uterus. When the placenta comes away from the uterus, but becomes trapped behind a semiclosed cervix. This is called a trapped placenta.
If you have a full bladder it may prevent the placenta from being delivered. If necessary, your midwife may insert a catheter to drain your bladder. If the placenta has separated and is ready to come out, it will slide easily through your vagina. If it hasn't completely separated, or if the cord is very thin when your midwife pulls, it may break. If this happens, you can usually help to deliver the placenta by pushing with a contraction. However, occasionally the cervix closes too much to allow the placenta out. A small piece of placenta, connected to the main part of the placenta by a blood vessel, may have been left behind in the uterus (a succenturiate lobe). Your midwife will examine the placenta and membranes carefully after your baby is born to ensure that they are complete. If she notices a vessel leading to nowhere, this should alert her to the possibility of part of the placenta being retained. Sometimes, a part of the placenta may stick to a scar from a previous caesarean section. This is a serious condition called a placenta accreta. This should be picked up during your pregnancy. Then plans can be made for you to have your baby in an obstetric unit, where you'll have the right level of care.
If the third stage is taking a while, you could try breastfeeding your baby or rubbing your nipples, to release the hormone oxytocin. This may cause your uterus to contract and help to expel the placenta. If you're sitting or lying down, you could try changing to a more upright position to allow gravity to help. If you chose a physiological third stage, you can switch to a managed third stage if the placenta doesn't come within an hour. Your midwife will give you an injection of an oxytoxic drug to make your uterus contract. She will then gently pull out the placenta. Following a managed third stage, if the placenta is retained, your midwife can give you another injection of an oxytocic drug. She may also try injecting oxytocin and saline into the umbilical vein of the umbilical cord. Or she may just wait a bit longer to see if it comes away on its own.
You are more likely to have a retained placenta if your baby is premature. This may be because the placenta was designed to stay put for 40 weeks. So if you have another premature labour, it may happen again. However, if the cord snapped, or if your cervix closed too quickly after having the oxytocic injection, you may consider a physiological third stage with your next baby. By allowing the placenta to deliver naturally, you avoid the possibility of the cervix closing too quickly and trapping the placenta. Talk about your options with your midwife. The prolonged use of syntocinon (artificial oxytocin) during labour has been linked to retained placentas. You may have had this if your labour was induced or speeded up. Bear in mind that with your next baby you may not need these interventions at all. http://www.babycentre.co.uk/a562148/retained-placenta#ixzz2dhDB2ykD