Retained placenta

Question 1

Definition of retained placenta

Answer 1

Failure of delivery of placenta within:

• 60 minutes if physiological
• 30 minutes if active 3rd stage

Question 2

Risk factors

Answer 2

Previous retained placenta
 Previous injury or surgery to the uterus
 Preterm delivery
 Induced labor
 Multiparity

Question 3

Causes

Answer 3

Constriction ring-reforming cervix
 Full bladder
 Uterine abnormality
 Morbid adherence of the placenta:
 Placenta Accreta
 Placenta Increta
 Placenta Percreta

Question 4

Management

Answer 4

If the placenta is undelivered after 30 minutes consider:
 Emptying bladder
 Breastfeeding or nipple stimulation
 Change of position – encourage an upright position

If bleeding: Immediately:
 Inform Obstetric Registrar/ Clinical Charge Midwife
 Insert large bore IV (16g)
 send group and hold urgently, ring and inform blood bank of urgency, request blood to be
available for theatre within 30 minutes
 send Full blood count
 Commence /continue syntocinon infusion 20units in a litre rate 250 mls per hour
 Measure and accurately record blood loss
 Prepare and complete appropriate documentation for theatre
 Transfer patient to theatre for manual removal of placenta (acuity one if ongoing bleeding)
 Antibiotics : Augmentin 1.2 g IV or Cefoxitin 1 g IV
 Vital signs, fundus, blood loss and fluid balance are observed and documented as clinically
indicated.
 Women whose blood group is RH negative are recommended to have a Kleihauer test with
appropriate Anti-D dose.
If not bleeding ensure the above steps are completed within 1 hour of diagnosis of retained
placenta

Question 5

Complications of Manual Removal of a Retained Placenta:

Answer 5

Perforation of uterus
Retained products
Infection

Question 6

Complications of a retained placenta

Answer 6

Uterine inversion
 Shock (hypovolemic)
 Postpartum hemorrhage
 Puerperal Sepsis
 Subinvolution
 Hysterectomy