Retained placenta is not a common condition, but because it’s serious, it will need to be managed by a medical team.

What causes retained placenta?

A placenta can be retained if your contractions aren’t strong enough to expel it, or if the cervix closes and traps the placenta inside your uterus.

You are more at risk of a retained placenta if you are over the age of 30, have a premature baby or if your first and second stages of labour were very long. It can also happen if you have a fibroid or another problem with your uterus.

Many women will have an injection of syntocinon (a synthetic version of the hormone oxytocin), which not only helps deliver the placenta but also helps reduce the risk of postpartum bleeding. Having this injection is called ‘active management’. If the mother chooses not to have the injection, it is called ‘expectant management’.

What are the symptoms of retained placenta?

The main symptom of retained placenta is that the placenta doesn’t completely come out of the uterus after the baby is born. Another symptom can be bleeding before the placenta comes out.

If a piece of placenta is left behind, 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

What is the treatment for a retained placenta?

Sometimes retained placenta can be treated simply if you empty your bladder, change position and have the doctor or midwife gently pull 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. Your doctor will use an instrument called a curette to scrape away the lining of the uterus.

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 after to make sure you are not bleeding.

If you do start to experience some of the symptoms mentioned above in the days and weeks after you have had your baby, it’s important to see your doctor immediately. It is not always obvious after the placenta has been delivered that some tissue may have been left behind and this can lead to infection and bleeding. If you are bleeding heavily after the birth, you will need surgery to investigate the cause.