No two labor experiences are identical, and there’s no clear way to predict how yours is going to go down even up until delivery day. While movies and TV shows often portray labor and delivery as a one-two-step process of pushing and screaming followed by a sweet ending with a mom holding her newborn bundle of joy, the real thing can be much different.
The truth is, labor can progress in fits and starts — and it’s not uncommon for a complication or other unforeseen problem to arise. One of the rarer pregnancy complications is called a retained placenta, and while it’s unlikely to happen to you, it's good to be aware of it all the same.
The good news: A retained placenta is very treatable — and it can't hurt your baby.
What is a retained placenta?
A retained placenta is a rare complication affecting only about 2 to 3% of all deliveries that occurs when all or a portion of the placenta is left inside the uterus after baby's birth.[1]
During pregnancy, the placenta is attached to the uterine lining to allow for the transfer of nutrients, oxygen, carbon dioxide and water from the mother’s blood to the baby, with carbon dioxide from the baby cycling back through the umbilical cord and placenta to the mother for elimination.
The placenta is made up of sections, each connected to the umbilical cord by its own set of vessels and a double-layer membrane that forms a see-through sac around the fetus.
After you have your baby, the final (or third) stage of labor is the delivery of the placenta during uterine contractions. Delivering the placenta usually occurs within five to 30 minutes after a vaginal delivery, and immediately after a C-section delivery.
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Sometimes, however, part or all of the placenta can be retained inside the womb because a portion has grown through the uterine muscle or is "caught" inside a corner of the uterus as it contracts down.
When the placenta is not delivered intact or placental expulsion does not happen within 30 to 60 minutes of the baby’s birth, it's known as a retained placenta.
What causes a retained placenta?
There are three different types of retained placenta, each of which has a different cause. They include:
- Placenta adherens, which happens because the uterine muscles don’t contract enough to make the placenta separate from the uterine wall and expel it from the womb.
- Trapped placenta, which happens when the placenta separates from the uterus but does not naturally exit the mother’s body. This can occur when the cervix begins to close before the entire placenta is excreted.
- Placenta accreta, which happens when the placenta grows into the deeper layer of the uterus and is unable to naturally detach from the organ. This is the most dangerous type of retained placenta and can lead to a hysterectomy and blood transfusions.
Who is at risk of having a retained placenta?
Women who are at risk of having a retained placenta[2] include those who've had:
- A previous C-section
- A previous dilation and curettage (D&C)
- A previous surgery for uterine fibroid removal
- A premature delivery before 34 weeks
- A stillborn baby
- Uterine abnormalities
- A long first or second stage of labor
- A retained placenta during a previous delivery
- Certain pregnancy complications such as placental abruption or velamentous cord insertion
What are the symptoms and signs of a retained placenta?
The most common sign of a retained placenta is when the organ that nourishes your baby during pregnancy fails to be delivered spontaneously within 30 and 60 minutes of childbirth.
If pieces of the placenta are still inside your body days or weeks after delivery, you may experience symptoms including:
- Fever
- Persistent heavy bleeding with blood clots
- Cramping and pain
- A foul-smelling discharge
A doctor can diagnose a retained placenta with certain imaging exams, like a transvaginal ultrasound.
What are the complications of a retained placenta?
Since a retained placenta occurs after delivery, there are no repercussions for the baby. But it can be risky for new moms.
In the time between the delivery of the baby and the delivery of the placenta, excessive bleeding or postpartum hemorrhage can occur, which can lead to significant blood loss, even putting the mother at risk of needing a blood transfusion and other emergency measures to stop the bleeding. Physicians and midwives are trained to follow steps to determine why a mother is bleeding excessively and get the hemorrhage under control as soon as possible.
On a lesser scale, if the pieces of retained placenta are very small and there’s no abnormal bleeding on the spot, it could lead to postpartum bleeding lasting longer than expected, excessive bleeding that starts around 10 to 12 days after delivery, or abnormal cramping and pain two to three weeks after delivery.
By 14 days postpartum, a placental scab forms and you may see an increase in red bleeding when the placenta scab falls off, which may go unnoticed because the uterus is already shrinking. But if there’s also an infection or small portion of retained placenta, new bleeding of bright red blood can start and become heavy, which warrants an ER trip or visit to your doctor.
How is a retained placenta treated?
Treatment requires removing the placenta or the portions of it that have stayed inside the womb. Immediately after delivery, this retained part can be removed manually or by using an instrument to assist.
If it’s delayed a week or two, depending on how much tissue is seen on an ultrasound, your doctor will likely recommend either a cervical exam, a D&C, or medications such as misoprostol with antibiotics (or a combination of these).
Can a retained placenta be prevented?
Some studies have suggested the following techniques can help prevent retained placenta:
- Uterine massage
- Medications such as oxytocin
- Controlled cord traction (applying pressure on the lower abdomen while simultaneously pulling on the umbilical cord — though this shouldn’t be done if you have a velamentous cord insertion)
Can I have a retained placenta again?
If you’ve had a retained placenta in one pregnancy, research shows that you may have about a 6 to 13% chance of having it in a later pregnancy too. Just make sure your doctor knows everything about your pregnancy history, and your labor and delivery team can work with you to develop the best birth plan for you.
Remember, all these scenarios are very unlikely to happen to you during labor and the delivery of your baby. In the rare instance that you do wind up having a retained placenta, your medical team will know what to do to minimize the risks and help you safely start on your journey of motherhood.
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