Retained placenta

What is retained placenta?

Retained placenta is when the placenta doesn’t completely come out of the uterus after the baby is born.

Sometimes, a piece of the placenta is left behind in the uterus (womb). It’s not common, but it can be serious. It can cause problems days or weeks after the birth.

Retained placenta can lead to severe infection or life-threatening blood loss for the mother.

How is the placenta delivered after birth?

After your baby is born, the placenta also needs to be delivered. This is called the third stage of labour.

You may choose to ‘actively manage’ this stage of labour. Meaning that you will receive an injection of Syntocinon (a synthetic version of the hormone oxytocin) to help your uterus contact and birth the placenta. Actively managing your 3rd stage of labour can take up to 30 minutes. This also helps reduce the risk of heavy bleeding from the vagina (called postpartum haemorrhage).

Some women choose not to have the oxytocin injection. This is called ‘expectant management’ or ‘physiological management of the third stage’. It means waiting for the placenta to be born naturally, usually with gravity and some contractions. This may take up to one hour.

It’s important to make an informed decision by discussing the options with your midwife or doctor. You may choose to write your preferences in a birth plan.

What causes retained placenta?

Sometimes the placenta takes longer than expected to be delivered. The placenta can be retained after your baby is born if:

• your contractions aren’t strong enough to expel it
• the placenta is unusually strongly attached to the wall of the uterus
• you have placenta accreta (when the placenta implants too deeply into the wall of the uterus)
• the cervix closes and traps the placenta inside your uterus

What are the signs and symptoms of retained placenta?

Retained placenta is when the placenta doesn’t completely come out of the uterus after the baby is born.

Sometimes a piece of placenta is left behind in the uterus. If this happens, you may develop symptoms days or weeks after the birth. These may include:

• fever
• a bad smelling discharge from the vagina
• heavy bleeding
• large pieces of tissue coming out of the vagina
• pain

It’s important to contact your doctor or medical team as soon as possible if you have any heavy bleeding from your vagina and/or pain in the days or weeks following birth.

If the bleeding and/or pain become significantly worse, call an ambulance on triple zero (000). Or go to your nearest hospital emergency department.

How is retained placenta diagnosed?

Your doctor or midwife will diagnose retained placenta if the placenta hasn’t completely come out of the uterus within 30 minutes - if you are actively manage or 1 hour - if you choose physiological management, after a vaginal birth.

At every birth, the midwife or doctor checks the placenta once it’s delivered. This is to check that none has been left in the uterus. But it is not always obvious if a small amount of tissue has been left behind.

If you have symptoms of retained placenta in the days or weeks after birth, your doctor may suspect that a piece of the placenta has been left behind. They may recommend an ultrasound scan. This is to check whether you have any retained placenta.

What is the treatment for retained placenta?

If you have just given birth, retained placenta might be treated by:

• emptying your bladder
• your doctor or midwife gently pulling on the umbilical cord.

If that doesn’t work, you will need a procedure to remove the placenta. You will be taken into surgery after the birth and given an epidural or anaesthetic so you don’t feel anything.

While you’re waiting for surgery, the medical team will keep a close eye on you to check you're not bleeding heavily (postpartum haemorrhage). The procedure itself is quick, but you will need to be monitored for several hours afterwards to make sure you are not bleeding.

It’s not always obvious after the placenta has been delivered that some placenta tissue may have been left behind. If you are bleeding heavily in the days or weeks after birth, you may need imaging tests or surgery to investigate the cause.

If you have an infection, you will need treatment with antibiotics.

What are the complications of a retained placenta?

Retained placenta can be serious. In rare cases, it can lead to life-threatening infection or blood loss (postpartum haemorrhage).

While there is usually some normal blood loss with birth, blood loss associated with retained placenta can be very severe. This is because the area in the uterus where the placenta is still attached can continue to bleed.

Postpartum haemorrhage can be divided into:

• primary postpartum haemorrhage – this happens within the first 24 hours after delivery
• secondary postpartum haemorrhage – this happens in the days and weeks following birth (between 24 hrs and 6 weeks after birth)

Diagnosing and managing retained placenta early helps prevent complications such as severe blood loss and infection.