Retained Placenta

Retained Placenta

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:

1. Poor voluntary expulsive effort after  prolonged labour
2. Atonic uterus
3. Hour  glass contraction

1. Morbid adherent placenta

Diagnosis of Retained Placenta:

1. Time spent  after delivery
2. Whether the placenta is retained with or without separation

Management of Retained Placenta:

1. Pt should be resuscited by giving iv Fluid and or blood transfusion
2. Bladder should be emptied by rubber catheter
   1. Separated
   2. Unseparated
   3. Complicated

Separated

1. To Expresses the placenta by controlled cord traction
2. Unseparated retained placenta manual removal of placenta under G/A

Complicated retained placenta with shock, hemorrhage & sepsis

1. Treatment of the shock
2. Treatment of the Hemorrhage
3. Treatment of the sepsis
   1. Intrauterine swab are taken for C/S
   2. Blood transfusion
   3. Broad spectrum  antibiotics
   4. General condition permits
   5. Manual removal of placenta

Complications of Retained Placenta:

(Retained placenta symptoms)

1. Hemorrhage
2. Shock-due to
   1. Blood loss
   2. Frequent attempts of abdominal manipulation to express the placenta out.
3. Puerperal sepsis
4. Risk of recurrence in next pregnancy.

Morbid Adherent placenta

• 3 forms

1. Placenta Accreta
2. Placenta Increta
3. Placenta Percreta

Placenta Accreta

• 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

1. Adherent area is separated with finger
2. Leaving behind the bit of placental tissue
3. With inj. Oxytocin & Ergometrine-effective uterine contraction is achieved
4. If uterus fails to contract- hysterectomy in parous women.
5. Conservative attitude in low parity- leaving behind the placenta which is expected to be autolysed in due course
6. Proper antibiotics should be given.
7. Methotraxate is to given

Source: Hasina Madam’s Lecture from RMC (Rajshahi Medical College) with some diagram of mine.