Once your baby is born, most of your hard work is over, but your labour is not. You still need to deliver your baby’s life supporting placenta in the third and final stage of labour. Sometimes if you are lucky, the placenta follows closely on baby’s heels, but this is not the norm. When it comes to delivering the placenta, you can choose between a managed and a natural third stage. We have discussed the difference between them in another article, but if you opt for a natural third stage, delivery of the placenta can take up to anything between 20 to 50 minutes.
Once the placenta is delivered, your doctor or midwife will inspect to ensure that it is intact. If even the tiniest piece of placenta remains behind, it is called a retained placenta. If ignored, a retained placenta is the biggest cause of post partum haemorrhaging.
Signs of a retained placenta
After the placenta is delivered, your uterus should start contracting to close up all the blood vessels and prepare to go back to its normal state. If only part of the placenta separates, the uterus can’t contract, so blood will flow uninterrupted. The wound will remain open instead of heal, so you will notice quite a bit of blood loss after delivering the placenta.
In addition to heavy vaginal bleeding, you might have a high fever. Sometimes, if a retained placenta is overlooked, symptoms will set in a few days after birth. The blood will be bright red, and come out as a constant flow, or in large gushes. In turn, it can lead to an infection, but it happens very rarely. A retained placenta is overlooked in less than one percent of pregnancies, to be exact.
Causes of a retained placenta
There are three main causes that can lead to pieces of the placenta being retained.
- The uterus stopped contracting, or is not contracting enough to separate the placenta from the uterine wall.
- The placenta might have detached completely, but gets trapped behind a semi-closed cervix.
- A full bladder can also hamper the placenta from being delivered, but generally your doctor will insert a catheter to drain your bladder anyway.
Treatment of a retained placenta
Treatment will depend on the cause. In most cases, your doctor will administer a shot of intravenous oxytocin to speed up your contractions to help expel the fragments. This usually works, but if the placenta is still not delivered, your doctor will have to remove it by hand. The procedure is painful without sedation, but you should not feel a thing, because an anaesthetist will numb the area for you.
If you have prolonged heavy bleeding for days after giving birth, your doctor will do an ultrasound scan to check for blood clots and placenta fragments. In the event, you will be admitted to hospital to have the placenta manually removed. Yes, it is an uncomfortable but quick procedure, but a necessary one.
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Source: Retained Placenta