Placenta Delivery – Can Placenta Retention Pose Life-Threatening Complications?

Placenta Delivery – Can Placenta Retention Pose Life-Threatening Complications?

Successful delivery means both mother and the baby are safe and healthy. It does not mean just by pushing the baby out and cutting the umbilical cord. Delivery of the placenta is an important part of childbirth failing to do can create life-threatening complications. Let’s know the complete part of this third stage of labor in this story.

Functions of placenta

A placenta is a disk or pancake shaped temporary organ that the woman’s body makes during pregnancy. It normally develops between 8-13 weeks and is attached to the side or top of the uterus. The baby is connected to the placenta via umbilical cord.

The main function of the placenta is to provide nourishment to the baby throughout the pregnancy. Other important functions include the production of estrogen, progesterone and human chorionic gonadotropin (hCG) hormone.

Placenta delivery

In majority of cases after the baby is delivered and the umbilical cord has been removed, the placenta will follow. The delivery of the placenta is also called as the third and final stage of the labor and delivery. It has to be expelled after the delivery failing to do can bring unwanted side effects.

That is why doctor usually evaluates the placenta after it has been delivered to make sure it has not been retained inside. The placenta has usually two sides; one from maternal side is dark red while the other one on the baby’s side is shiny and translucent.

What is retained placenta?

Labor and delivery has mainly three stages. First is when a woman start to experience contractions and the cervix is dilated (widened). Second stage is when the baby is delivered while the third stage is when placenta is delivered. Typically, a pregnant woman’s body releases the placenta within a time span of 30 minutes after delivery of the baby.

However, in cases where the placenta or part of it remain in the uterus for more than half an hour after the delivery of the baby, it is then considered as retained placenta. If placenta remains inside for a long time then it can bring dangerous complications for the mother including excessive blood loss and infection.

Is placenta retention a common occurrence?

Retained placenta is not a common problem. It is estimated that incidence of placenta retention occurs in about 0.5 to 1 percent of cases. The rate of occurrence or risk increases for women who have history of uterine scarring or retained placenta.

What causes a placenta to remain in the body?

Mainly, there are three reasons of placenta retention. These include:

Uterine Atony – This is the most common reason of a retained placenta. In this type, the uterus stops contracting or does not contract enough and force the placenta to come out of the uterus.

Trapped Placenta – This type of retention occurs when the placenta separates from the uterus but does not leave the body. This often happens when the cervix begins to close before the expulsion of the placenta, causing it to get trapped behind the cervix.

Placenta Adherens – This is also one of the most common reasons in which the part or complete placenta remains firmly attached to the wall of the uterus. Placenta Adherens occurs when during pregnancy, the blood vessels or part of the placenta gets deeply rooted into the uterine wall, also known as placenta accreta. This is more likely to occur when a woman had history of c-section scarring.

Other reasons might include uterine abnormality and hormonal factors.

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Signs and symptoms of placenta retention

The clearest sign is when placenta does not expel after the childbirth. However, if for some reasons the placenta delivery is missed by the doctor, following symptoms can be observed:

  • Fever
  • Persisting bleeding
  • Foul smelling vaginal discharge containing large pieces of tissues
  • Persistent pain

Are there any risk factors of retained placenta?

There are various factors that are considered to increase the likelihood of retained placenta. These are:

How the retained placenta is diagnosed?

The condition can be diagnosed by carefully checking the expelled placenta and see whether part of it is still there in the uterus. In most cases, doctors are able to spot the missing part but in some cases, the team might miss it. When this happens, a woman will start experiencing symptoms after the delivery.

If the doctor suspects or the woman reports about the above mentioned symptoms, the doctor will use an ultrasound to evaluate the womb and give the treatment accordingly.

What complications a woman could face in case of retained placenta?

Placenta should come within 30 minutes of child delivery. However, if it doesn’t, it can lead to excessive blood loss in the first 24 hours of the delivery. This is known as primary postpartum hemorrhage. It can also lead to infections which can create further problems for the mother.

How the problem of retained placenta is treated?

The treatment will include the removal of the entire placenta or the missing portion, depending on the case. Following methods can used for the purpose:

Breastfeeding

In certain cases, breastfeeding can be an effective option for accelerating the process of contraction and expel the placenta. However, breastfeeding with retained placenta can be difficult since there would be lack of healthy milk supply while the placenta is still in the body.

Medication

If the placenta doesn’t expel on its own, the doctor would give Pitocin (oxytocin) for relaxing or contracting the uterus. The doctor may also inject saline in the umbilical vein so that the placenta gets out of the body.

Manual removal

The doctor will first introduce a catheter to empty the bladder and then administer antibiotics intravenously to prevent infection. The woman shall also be given local anesthesia before the doctor place her hands into the uterus and remove the attached placenta.

Curettage

If the retention is due to placenta accreta, the manual removal will be done in a partial manner while curettage handles the rest. In curettage, a scoop-shaped surgical instrument is used to scrap and get rid of the placental remains.

Controlled cord traction

This method is used in cases where placenta gets detached from uterus but still not coming out. In such case, the umbilical cord is gently pulled while applying counter pressure to deliver the placenta.

Hysterectomy

In cases where the placenta is deeply rooted into the uterus, the only option remain is to surgically remove the entire uterus. This procedure will prevent a woman from getting pregnant in future.

Takeaway

The event of childbirth is indeed an exciting one. In majority of cases, placental delivery is not painful and happens very quickly after the childbirth. The new mother who had faced excruciating pain during the labor might not even notice the delivery of placenta. She might be busy cuddling with her child.

But the fact remains that the placenta should be delivered as soon as possible and that too in its entirety. Some woman want to save placenta to plant them or even eat them to reduce postpartum depression and anemia. However, there is no such scientific study that confirms that eating placenta have benefits.

Sources

1. Delivering the placenta with active, expectant or mixed management in the third stage of labor. read more
2. Third stage of labour. (2015). read more
3. Stages of childbirth: stage III. (2015, August). 
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