Definition of Retained Placenta:
When placenta is not expelled out 30 minutes after birth of the baby. Symptoms of retained placenta are described below.
Causes of Retained Placenta:
- Poor voluntary expulsive effort after prolonged labour
- Atonic uterus
- Hour glass contraction
- Morbid adherent placenta
Diagnosis of Retained Placenta:
- Time spent after delivery
- Whether the placenta is retained with or without separation
Management of Retained Placenta:
- Pt should be resuscited by giving iv Fluid and or blood transfusion
- Bladder should be emptied by rubber catheter
- To Expresses the placenta by controlled cord traction
- Unseparated retained placenta manual removal of placenta under G/A
Complicated retained placenta with shock, hemorrhage & sepsis
- Treatment of the shock
- Treatment of the Hemorrhage
- Treatment of the sepsis
- Intrauterine swab are taken for C/S
- Blood transfusion
- Broad spectrum antibiotics
- General condition permits
- Manual removal of placenta
Complications of Retained Placenta:
(Retained placenta symptoms)
- Shock-due to
- Blood loss
- Frequent attempts of abdominal manipulation to express the placenta out.
- Puerperal sepsis
- Risk of recurrence in next pregnancy.
Morbid Adherent placenta
- 3 forms
- Placenta Accreta
- Placenta Increta
- Placenta Percreta
- Placenta is directly anchored to the myometrium partially or completely without any intervening decidua
- Placenta Increta- Varying degree of penetration of villi into muscle bundle
- Placenta Percreta- Penetration of villi in to serosal layer.
Management Partial morbid adherent placenta
- Adherent area is separated with finger
- Leaving behind the bit of placental tissue
- With inj. Oxytocin & Ergometrine-effective uterine contraction is achieved
- If uterus fails to contract- hysterectomy in parous women.
- Conservative attitude in low parity- leaving behind the placenta which is expected to be autolysed in due course
- Proper antibiotics should be given.
- Methotraxate is to given
Source: Hasina Madam’s Lecture from RMC (Rajshahi Medical College) with some diagram of mine.