Retained Placenta

Overview

After a baby is born, the placenta, the organ that nourished the baby during pregnancy, normally separates from the wall of the womb and is delivered within a short time. A retained placenta occurs when all or part of the placenta is not delivered within the expected time frame, or when fragments of placental tissue remain in the womb after the rest has come away.

This matters because the womb needs to contract down and the placenta to detach in order to close off the blood vessels that supplied it. If placental tissue stays behind, it can prevent the womb from contracting properly, leading to heavy bleeding, or it can become a source of infection. A retained placenta is treated promptly because of these risks, and with timely care most women recover well.

Symptoms

A retained placenta may be recognized soon after birth or in the days that follow. Signs can include:

• The placenta not being delivered within the expected time after birth
• Heavy or ongoing vaginal bleeding after delivery
• Passing large blood clots
• Persistent cramping or abdominal pain
• Fever, chills, or foul-smelling vaginal discharge if infection develops
• Feeling faint, dizzy, or weak from blood loss

Heavy bleeding after childbirth (postpartum hemorrhage), signs of significant blood loss, or fever are emergencies. They need immediate medical attention to prevent serious harm.

Causes

A retained placenta happens when the placenta fails to separate and deliver normally. The main reasons include:

• Trapped placenta: The placenta separates but is held in the womb because the cervix has begun to close.
• Poor womb contraction: The womb does not contract strongly enough to push the placenta out.
• Abnormally attached placenta: The placenta is attached more deeply or firmly to the womb wall than usual, making separation difficult.
• Retained fragments: Part of the placenta breaks off and remains after the main placenta is delivered.

Certain factors during pregnancy and delivery make these problems more likely.

Risk Factors

• A previous retained placenta or previous womb surgery, including cesarean section
• Premature birth
• A long labor
• Older maternal age
• Conditions in which the placenta is abnormally attached

Diagnosis

A retained placenta is usually identified soon after birth or when bleeding or infection prompts investigation:

• Examination of the delivered placenta: Checking that the placenta and membranes are complete; missing pieces suggest retained tissue.
• Clinical assessment: Observing for heavy bleeding, a poorly contracting womb, or signs of infection.
• Ultrasound: Used to look inside the womb for remaining placental tissue, especially when bleeding or infection occurs later.

Treatment

Treatment aims to remove the retained tissue and control any bleeding or infection. Approaches include:

• Helping the placenta deliver: Encouraging womb contractions, emptying the bladder, breastfeeding, and a controlled pull on the cord by a trained clinician.
• Medication: Drugs that help the womb contract.
• Manual removal: A clinician removes the placenta by hand, usually with pain relief or anesthesia.
• Surgical removal: A procedure to remove remaining tissue from the womb if other measures do not work or fragments remain.
• Treating complications: Managing heavy bleeding with fluids, medication, or blood transfusion if needed, and antibiotics for infection.

Prompt treatment greatly reduces the risk of serious complications, and most women recover fully.

Prevention

A retained placenta cannot always be prevented, but careful care around birth reduces the risk and catches problems early:

• Active management of the delivery of the placenta, as offered by maternity teams
• Careful examination of the placenta after birth to check it is complete
• Attending postnatal checks and reporting heavy bleeding, pain, or fever

When to See a Doctor

A retained placenta during delivery is managed immediately by the birth team. After going home, seek emergency care right away if you have:

• Heavy vaginal bleeding, such as soaking a pad in an hour, or large clots
• Feeling faint, dizzy, weak, or a fast heartbeat
• Fever, chills, or foul-smelling discharge
• Severe or worsening abdominal pain

These can signal postpartum hemorrhage or infection from retained tissue and require urgent treatment. When in doubt, contact your maternity team or call emergency services.

Related Topics

Frequently Asked Questions

References

1. MedlinePlus, U.S. National Library of Medicine. Postpartum care.
2. National Health Service (NHS). Retained placenta.
3. World Health Organization (WHO). Postpartum haemorrhage.
4. American College of Obstetricians and Gynecologists (ACOG). Postpartum Hemorrhage.