What is a retained placenta?
A retained placenta refers to when the placenta fails to deliver spontaneously within 30 minutes after delivery of the baby. Normally, the placenta detaches from the uterine wall shortly after childbirth and is expelled through the vagina. With a retained placenta, all or part of the placenta remains attached to the uterus.
How common is retained placenta?
Retained placenta occurs in around 1-3% of vaginal deliveries. The risk is higher in women who have conditions like uterine infections, prolonged labor, or a history of retained placenta in previous pregnancies.
Does retained placenta cause pain?
Yes, a retained placenta can cause significant pain and discomfort in the hours and days following childbirth. Some key points about pain with retained placenta:
- Severe lower abdominal pain is common as the uterus is unable to contract and clamp down on blood vessels that were attached to the placenta.
- Pain may start soon after delivery or be delayed up to 24 hours.
- Pain is often described as severe cramping or contractions, similar to labor pains.
- Back pain may also occur as blood accumulates behind the placenta.
- Pain usually continues until the placenta detaches fully or is removed.
Other symptoms of retained placenta
Along with pain, other symptoms may include:
- Heavy vaginal bleeding – excess blood loss occurs if the placenta blocks the cervix.
- Signs of infection – fever, foul discharge, uterine tenderness.
- Blood clots passing from the vagina.
- No signs of placental expulsion within 1 hour of birth.
- Uterus remains enlarged and fails to contract.
Risks of retained placenta
If left untreated, retained placenta can lead to:
- Hemorrhage – heavy bleeding resulting in low blood pressure, shock.
- Infection – bacteria trapped behind placenta can cause endometritis, sepsis.
- Blood clots – improper placental separation increases clotting risk.
- Need for blood transfusion, hysterectomy in severe cases.
- Rarely, death can occur from uncontrolled hemorrhage.
Diagnosis
Retained placenta is often diagnosed based on:
- Failure of placental delivery within 30 minutes of birth.
- Enlarged, boggy uterus upon abdominal exam.
- Significant bleeding or cramping pain.
- Ultrasound to visualize placental remnants.
Treatment
Treatment options may include:
- Manual removal – Doctor detaches placenta with fingers through the cervix.
- Medications – Oxytocin to contract uterus and expel placenta.
- Curettage – Scraping uterine lining to detach placenta.
- Hysterectomy – Surgical removal of uterus for severe cases.
- Pain management – IV fluids, painkillers to control pain.
- Antibiotics – To prevent/treat uterine infection.
Prevention
Some measures to help prevent retained placenta include:
- Managing conditions like fibroids, lupus, thyroid disorders.
- Having trained birth attendants to monitor placental delivery.
- Allowing the placenta to deliver spontaneously without tugging the cord.
- Using preventive antibiotics in high-risk cases.
- Avoiding trauma to the uterine lining during delivery.
Conclusion
In summary, retained placenta is a postpartum complication where the placenta fails to detach and exit the uterus after delivery. This can cause severe abdominal and back pain from continued uterine cramping, excessive bleeding, and risks of infection. Manual removal, medications, or surgery are used to manage retained placenta. Prompt diagnosis and treatment helps minimize complications. While retained placenta can be alarming, outcomes are often good with appropriate care.