Retained placenta is a condition in which all or part of the
placenta
The placenta is a temporary embryonic and later fetal organ that begins developing from the blastocyst shortly after implantation. It plays critical roles in facilitating nutrient, gas and waste exchange between the physically separate mate ...
or membranes remain in the
uterus
The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The ...
during the third stage of labour.
[Placenta (retention)]
/ref> Retained placenta can be broadly divided into:
* failed separation of the placenta from the uterine lining
* placenta separated from the uterine lining but retained within the uterus
A retained placenta is commonly a cause of postpartum haemorrhage
Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, v ...
, both primary and secondary.[Placenta (retention)]
/ref>
Retained placenta is generally defined as a placenta that has not undergone placental expulsion within 30 minutes of the baby’s birth where the third stage of labor has been managed actively.[Maternity - Prevention, Early Recognition & Management of Postpartum Haemorrhage (PPH)]
From Department of Health, NSW. 21-Oct-2010
Signs and symptoms
Risks of retained placenta include hemorrhage and infection. After the placenta is delivered, the uterus should contract down to close off all the blood vessels inside the uterus. If the placenta only partially separates, the uterus cannot contract properly, so the blood vessels inside will continue to bleed. A retained placenta thereby leads to hemorrhage.
Management
Drugs, such as intraumbilical or intravenous oxytocin, are often used in the management of placental retention. It is useful ensuring the bladder is empty.[ However, ergometrine should not be given as it causes tonic uterine contractions which may delay placental expulsion.][ Controlled cord traction has been recommended as a second alternative after more than 30 minutes have passed after stimulation of uterine contractions, provided the uterus is contracted.][ Manual extraction may be required if cord traction also fails,][ or if heavy ongoing bleeding occurs. There is currently uncertainty about the effectiveness of anaesthesia or analgesia for manual extraction, in terms of pain and the risk of postpartum haemorrhage.]placenta accreta
Placenta accreta occurs when all or part of the placenta attaches abnormally to the '' myometrium'' (the muscular layer of the uterine wall). Three grades of abnormal placental attachment are defined according to the depth of attachment and invas ...
'').
However, in birth centers and attended home birth environments, it is common for licensed care providers to wait for the placenta's birth up to 2 hours in some instances.
Other animals
Retention of fetal membranes
The fetal membranes are the four extraembryonic membranes, associated with the developing embryo, and fetus in humans and other mammals.. They are the amnion, chorion, allantois, and yolk sac. The amnion and the chorion are the chorioamniotic me ...
(afterbirth) is observed more frequently in cattle than in other animals. In a normal condition, a cow’s placenta is expelled within a 12-hour period after calving.[Retained Placentas]
/ref>
References
{{Reflist
Obstetrics
Midwifery