Retained Placenta Causes Complications and Treatment

A retained placenta occurs when all or part of the placenta remains inside the uterus after child birth.  Normally the placenta is delivered within minutes to an hour after child birth. For some women, the placenta doe not deliver naturally and must be physically removed.

There are three main types of retained placenta:

Trapped Placenta: The placenta detaches from the uterus but becomes trapped due to the cervix closing.

Partial Accreta:  The placenta grows into and becomes deeply attached to the uterus. This prevents detachment.

Placenta Adherens:  The muscular layer of the uterus fails to contract.

Retained placenta can occur for several reasons or for no reason at all.

Causes of retained placenta include:

Weak or insufficient uterine contractions: Uterine contractions are what cause the placenta to detach and ultimately become expelled from the vagina. If the muscle (the uterus is a series of tissue layers, mostly comprised of muscle tissue) contractions are weak or uncoordinated, the placenta will not be able to come out on its own.

Uterine anomalies: An abnormally shaped uterus can prevent the placenta from being expelled.

Hormonal Causes: During childbirth, the hormone oxytocin is released into the blood. Oxytocin is responsible for uterine muscle contractions. If for some reason, adrenaline is released into the blood (adrenaline is a hormone released into the blood during “fight or flight” response) oxytocin release can be inhibited and therefore prevent the uterus from contracting.

Treatment for retained placenta

Treatment for retained placenta depends on the cause.  For women experiencing a placenta that has separated from the uterine wall but are unable to deliver the placenta, many doctors perform what is called “Controlled Cord Traction.” With CCT, the umbilical cord is lightly pulled on to help the body expel the placenta.

Manual removal of the placenta can either be performed in the delivery room or in an operating room. Manual removal can involve a doctor placing their hand inside the uterus and gently removing the placenta from the uterine wall. When the placenta is separated, the doctor can then take hold of the placenta, remove it from the uterus and then vagina.

In some instances, the placenta is unable to be removed whole so it is removed in pieces. Sometimes it is also necessary to use surgical tools to scrape the uterus to remove all placental debris.

In cases where the placenta has deeply grown into the uterus, removal is only possible by hysterectomy. A hysterectomy is the surgical removal of the uterus. A woman who undergoes a hysterectomy will be unable to carry any future pregnancies.

Risks:

A retained placenta is a potential life threatening situation. After the placenta is delivered, the uterus contracting causes the blood vessels within it to constrict. If the placenta is retained, the uterus is unable to perform this function. If the blood vessels are not closed off, they continue to bleed. This could cause the women to lose a large amount of blood and possibly require blood transfusions.

A retained placenta, specifically in instances where placental debris is left within the uterus, can cause severe infection and fertility issues.  Labor and delivery professionals are trained and aware of the signs and symptoms of retained placenta and know how to treat them accordingly. Incidence of retained placenta is actually quite low and so are complications.