Understanding Retained Placenta: Symptoms, Causes and Care

Written by Medicover Team and Medically Reviewed by Dr Punnamaraju L Srinitya , Obstetrics

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

When the placenta does not fully detach from the uterine wall or is not delivered after childbirth, it is called retained placenta. This can lead to complications and require medical intervention. The exact cause of retained placenta is not always clear, but factors like a history of uterine surgeries or infections may increase the risk.

It is important to seek prompt medical attention if you suspect you may have a retained placenta to prevent potential complications. Your healthcare provider can offer guidance and treatment options tailored to your specific situation.

What Are the Types of Retained Placenta?

Retained placenta can occur in different forms depending on why the placenta is not delivered after childbirth. These include placenta adherens, trapped placenta, and abnormally adherent placenta.

Placenta Adherens: This type of retained placenta occurs when the uterus does not contract strongly enough to separate and expel the placenta.
Trapped Placenta: The placenta separates from the uterine wall but becomes trapped behind a closing cervix and cannot be delivered.
Placenta Accreta Spectrum: The placenta attaches too deeply to the uterine wall, making normal separation difficult.
Placenta Increta: The placenta grows into the muscular wall of the uterus.
Placenta Percreta: The placenta grows through the uterine wall and may extend into nearby organs, such as the bladder.
Partial Retained Placenta: Only a portion of the placenta or placental tissue remains inside the uterus after childbirth.

What Are the Symptoms of Retained Placenta?

Symptoms of retained placenta may include heavy or persistent bleeding after childbirth, fever, foul-smelling vaginal discharge, and abdominal pain. It is essential to seek medical attention promptly if you suspect you have a retained placenta to prevent complications.

Heavy Bleeding: Heavy bleeding that continues after childbirth may be accompanied by severe cramping or pain in the lower abdomen.
Foul-Smelling Discharge: Persistent foul-smelling vaginal discharge may indicate an infection associated with retained placental tissue.
Weakness or Dizziness: Heavy blood loss may cause weakness, dizziness, lightheadedness, or persistent fatigue.
Delayed Milk Production: Retained placental tissue can sometimes interfere with the hormonal changes needed for normal milk production.
Fever or Chills: Persistent fever or chills may be signs of an infection that develops when placental tissue remains in the uterus.

What Causes a Retained Placenta?

Retained placenta may occur when the uterus does not contract adequately, the placenta does not fully separate, or the placenta is abnormally attached to the uterine wall. Placenta accreta spectrum, uterine abnormalities, previous cesarean sections, and other pregnancy-related factors may also contribute.

Uterine Atony: The uterus may fail to contract properly after childbirth, preventing the placenta from separating and being expelled.
Incomplete Placental Separation: Parts of the placenta may remain attached to the uterine wall after delivery.
Uterine Abnormalities: Conditions such as uterine fibroids or structural abnormalities can interfere with placental separation and delivery.
Placenta Accreta Spectrum: The placenta may attach too deeply to the uterine wall, making normal separation difficult.
Trapped Placenta: The placenta may separate but become trapped inside the uterus when the cervix begins to close.

When Should You See a Doctor for Retained Placenta?

Medical evaluation by an Obstetrician and Gynecologist is essential when the placenta is not delivered after childbirth or when heavy bleeding, severe abdominal pain, fever, or foul-smelling discharge develops. Prompt assessment can identify retained placental tissue, control bleeding, treat infection, and prevent serious postpartum complications.

You should see a doctor if you have:

Persistent abdominal or pelvic pain after childbirth.
Fever, chills, or foul-smelling vaginal discharge.
Ongoing bleeding that is heavier or lasts longer than expected.

Get medical help immediately if:

You have sudden or very heavy vaginal bleeding.
You feel faint, dizzy, confused, or extremely weak.
You develop severe abdominal pain, breathing difficulty, or signs of shock.

These could be signs of serious retained placenta complications needing urgent care.

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How Is Retained Placenta Diagnosed?

A healthcare provider may check for bleeding, examine the abdomen and uterus, and use imaging tests to look for remaining placental tissue. Blood tests may help assess blood loss or detect signs of infection. Prompt diagnosis is crucial for proper treatment and prevention of complications.

Physical Examination: A healthcare provider may examine the uterus and assess bleeding, uterine tone, and other signs of retained placental tissue.
Ultrasound: An ultrasound scan may help identify placental tissue remaining within the uterine cavity.
Blood Tests: Tests such as a complete blood count (CBC) can assess blood loss and look for signs of infection.
Magnetic Resonance Imaging (MRI): In selected cases, MRI may provide detailed images when abnormal placental attachment is suspected.
Hysteroscopy: A thin, lighted instrument may be inserted through the cervix to examine the inside of the uterus and identify retained tissue in selected cases.

How Is Retained Placenta Treated?

Treatment options for retained placenta may include manual removal by a healthcare provider, medication to help the uterus contract, or a procedure such as dilation and curettage (D&C) to remove retained placental tissue. In some cases, surgery may be necessary. It is crucial to seek medical attention promptly to prevent complications.

Manual Removal: A healthcare provider may manually remove the placenta under appropriate pain relief or anesthesia when it does not deliver after childbirth.
Medications: Oxytocin or other uterotonic medications may be administered to help the uterus contract and control bleeding.
Dilation and Curettage: A D&C procedure may be used to remove retained placental tissue from the uterus when necessary.
Hysteroscopic Removal: In selected cases, retained tissue may be removed using a hysteroscope to directly visualize the uterine cavity.
Blood Transfusion and Supportive Care: Severe blood loss may require intravenous fluids, blood transfusion, and other emergency treatment.
Surgery: Surgery may be necessary for severe bleeding or placenta accreta spectrum when other treatments are ineffective.

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What Are the Risk Factors for Retained Placenta?

Several factors may increase the likelihood of retained placenta, including a previous retained placenta, prolonged labor, previous cesarean section, uterine fibroids, placenta previa, advanced maternal age, and multiple previous pregnancies.

Previous Retained Placenta: A history of retained placenta increases the risk of recurrence in future pregnancies.
Prolonged Labor: A long or complicated labor may increase the likelihood of placental retention.
Multiple Previous Pregnancies: Women who have had several pregnancies may have an increased risk.
Advanced Maternal Age: Maternal age over 35 years may be associated with a higher risk.
Placenta Previa: A placenta that partially or completely covers the cervix can increase the risk of abnormal placental attachment and retention.
Previous Uterine Surgery: Cesarean delivery or other uterine surgery may increase the risk of abnormal placental attachment.

What Are the Complications of Retained Placenta?

Retained placenta can cause serious complications if it is not recognized and treated promptly. The most important risks are excessive bleeding and infection.

Postpartum Hemorrhage: Retained placental tissue can prevent the uterus from contracting properly and cause severe bleeding.
Uterine Infection: Remaining placental tissue can increase the risk of postpartum infection.
Anemia: Significant blood loss can reduce red blood cell levels and cause weakness and fatigue.
Sepsis: An untreated uterine infection can spread through the bloodstream and become life-threatening.
Shock: Severe blood loss may cause dangerously low blood pressure and inadequate blood flow to vital organs.

Can Retained Placenta Be Prevented?

Retained placenta cannot always be prevented, but identifying risk factors before delivery and carefully managing the third stage of labor can help reduce complications. Women with a previous retained placenta or placenta accreta spectrum should discuss their delivery plan with their healthcare team.

Prenatal Care: Regular pregnancy check-ups can help identify placenta previa, abnormal placental attachment, and other risk factors.
Review of Pregnancy History: Informing the healthcare team about previous retained placenta or uterine surgery can support delivery planning.
Active Management After Birth: Appropriate use of uterotonic medication and careful monitoring after delivery can reduce the risk of severe bleeding.
Planned Specialist Care: Pregnancies with suspected placenta accreta spectrum may require delivery in a hospital with specialist obstetric and surgical support.

Frequently Asked Questions

1. What early signs should I look for with Retained Placenta?

Early signs of Retained Placenta include prolonged bleeding, severe cramping, foul-smelling discharge, and fever. Prompt medical attention is crucial.

2. What are the recommended do's and don'ts for managing Retained Placenta?

Do seek prompt medical attention. Don't attempt to remove the placenta yourself. Follow your healthcare provider's advice for treatment and monitoring.

3. Are there any risks associated with untreated Retained Placenta?

Yes, risks of untreated retained placenta include infection, heavy bleeding, and potential damage to the uterus. Treatment is important to prevent complications.