Retained placenta

This is when part of the placenta remains in the womb after giving birth. A retained placenta needs to be treated early to prevent complications.

What is a retained placenta?

After your baby is born, your womb will carry on contracting and the placenta is delivered. This is called the third stage of labour.

Sometimes the placenta or part of the placenta or membranes can remain in the womb, which is known as retained placenta. If this isn't treated, it can cause life-threatening bleeding (known as primary postpartum haemorrhage), which is a rare complication in pregnancy.

What causes a retained placenta?

A retained placenta may be caused by:

  • the uterus not contracting properly after the baby is born
  • the umbilical cord snapping (this isn’t very common and will not hurt your baby if managed quickly – your midwife will simply clamp the cord to prevent any bleeding)
  • the placenta attaching abnormally deeply into the wall of the uterus – this is rare.

How common is a retained placenta?

It’s not very common. A retained placenta happens in about 3% of vaginal deliveries. It can also sometimes happen after a caesarean section.

Certain things increase the risk of having a retained placenta. These include:

One study has said that you’re more likely to have a retained placenta if the same thing happened after your own birth or after the baby’s father’s birth.

How is the placenta usually delivered?

If you have a caesarean section,  the placenta will also be delivered after your baby is born.

If you have a vaginal birth, there are usually two options for delivering the placenta.

The first option is called active management. This means you’ll have an injection of a drug called oxytocin into your thigh as you give birth. This makes your womb contract, so the placenta comes away from the wall of your womb. You’ll probably deliver the placenta within 30 minutes.

The second option is called physiological management. This means that you will deliver the placenta without any medications or hormones, which can take up to an hour. Find out more about delivering the placenta.

There are a few other things your midwife may do to help the womb contract and the placenta separate during the third stage of labour. These include:

  • helping you empty your bladder
  • asking you to breastfeed your baby
  • massaging the top of your uterus through your tummy
  • asking you to change your position (for example, by moving to a sitting or squatting position).

How is a retained placenta diagnosed?

If your placenta has not delivered within the following timescales, you’ll be diagnosed with a retained placenta.

  • 1 hour of your baby’s birth if you have physiological management
  • within 30 minutes of your baby’s birth if you have active management.

If you’ve tried physiological management but the placenta hasn’t delivered, your midwife will talk to you about moving to active management. If this doesn’t work, your midwife or doctor will talk to you about options for removing it manually.

How is retained placenta treated?

Bleeding after giving birth is normal, but if you have a retained placenta your risk of heavy bleeding increases. You may be put on an intravenous drip (hormones and fluids), which will help reduce this risk.

If your midwife thinks that the placenta needs removing manually, you’ll be taken to the hospital labour ward if you’re not there already. Your birth partner and baby may be able to come with you to theatre, if you want them to. If you don’t want them to come with you or there is a medical reason why they can’t come, your baby will stay with your birth partner.

A doctor will give you a vaginal examination to assess where exactly the placenta is. This can be painful, so you’ll be offered some pain relief. Tell the midwife or doctor if you are still in pain during the examination as they can stop and give you more medication.

You’ll be advised to have an epidural or spinal anaesthetic when the placenta is removed. With either, you’ll be awake but pain free. If the placenta is ‘sitting in the cervix’, it can be easily pulled down the vagina. If it is still up in the cavity of the uterus, the doctor will place their fingers inside the uterus to detach the placenta and remove it. Their other hand is placed firmly on your tummy to steady the top of the uterus.

Removing the placenta manually needs to be done within a few hours of delivery, which will help avoid heavy blood loss (haemorrhage). There is a risk of infection with this procedure, so you will be prescribed antibiotics.

What are the symptoms of retained placenta?

Essentially, the symptom of retained placenta is the placenta not delivering after you give birth.

However, sometimes part some of the placenta may deliver, but some placental tissue or membranes can stay in the uterus. This may go unnoticed and can cause infection or heavy bleeding.

It’s normal to feel some discomfort, cramping and bleeding after birth. But contact your doctor or midwife if you have any of these symptoms in the days and weeks after giving birth:

  • a fever
  • a foul-smelling discharge from the vaginal area
  • large pieces of tissue coming from the placenta
  • heavy bleeding  – it’s difficult to say how much bleeding is ‘heavy’ but contact your midwife if you have any concerns – it may be helpful to put a sanitary towel in your pants (not a tampon) so you can show your midwife or doctor
  • pain that doesn’t stop.

You may need to go back to hospital and be checked for retained placenta.

Always contact your doctor, midwife or health visitor if you’re worried about any symptoms after having a baby.

Will I have a retained placenta next time?

If you’ve had a retained placenta in a previous pregnancy, you do have a higher risk of it happening again. There’s nothing you can do to lower the risk, but this doesn’t mean it will definitely happen again in this pregnancy.

Talk to your midwife if you have any concerns about your next pregnancy.

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Sources

NHS Choices. What complications can affect the placenta? https://www.nhs.uk/common-health-questions/pregnancy/what-complications-can-affect-the-placenta/ (Page last reviewed: 26/09/2018. Next review due: 26/09/2021)

Royal Berkshire NHS Foundation Trust. Manual Removal of a retained placenta http://www.royalberkshire.nhs.uk/patient-information-leaflets/Maternity/Maternity---manual-removal-of-retained-placenta.htm (Page last reviewed: Nov 2011. Next review due: April 2019)

Weeks, AD. (2008) The retained placenta. Best practice and research. Clinical obstetrics & gynaeacology 2008 Dec;22(6):1103-17. doi: 10.1016/j.bpobgyn.2008.07.005. Epub 2008 Sep 14.

Endler, M et al (2018) The inherited risk of retained placenta: a population-based cohort study. BJOG: an international journal of obstetrics and gynaecology 2018 May;125(6):737-744. doi: 10.1111/1471-0528.14828. Epub 2017 Sep 20.

NICE (2014). Intrapartum care for healthy women and babies. National Institute for health and care excellence https://www.nice.org.uk/guidance/cg190

American Pregnancy Association (2017) Retained placenta https://americanpregnancy.org/pregnancy-complications/retained-placenta/

Alufi A et al (2017) Reoccurrence of retained placenta at a subsequent delivery: an observational study. The journal of maternal-fetal & neonatal medicine 2017 May;30(9):1006-1009. doi: 10.1080/14767058.2016.1197902. Epub 2016 Jun 20.

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Last reviewed on June 11th, 2019. Next review date June 11th, 2022.

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