Retained placenta is a rare complication during the third stage of labor where the placenta is not delivered. Medical intervention is required to remove it, and it can be dangerous. The reasons for this complication include uterine atony, trapped placenta, and placenta accreta. The risks of a retained placenta are bleeding and uterine infections. Signs are obvious to a doctor, and interventions vary depending on the birth plan.
A retained placenta is a relatively rare complication that can occur during the third stage of labor where the placenta is held within the body instead of being delivered. In one of every 100 to 200 births, the placenta is not delivered as expected and medical intervention is required to remove it. Retained placenta can be dangerous, but is usually caught early by vigilant midwives, doctors, and nurses.
The third stage of labor lasts from delivery of the newborn to the delivery of the afterbirth, also known as the afterbirth. Most women deliver the placenta within an hour of giving birth, and in some cases, it can follow within minutes after delivery. When not given naturally, medications can be used to stimulate uterine contractions to push it out, women can be massaged to encourage contractions, or the placenta can be manually removed by a healthcare professional.
There are a number of reasons why this complication occurs. One is uterine atony, in which the uterus relaxes after delivery instead of contracting to push the placenta out. Another reason is a trapped placenta, where the placenta gets stuck behind the cervix, an especially common problem if the umbilical cord is pulled from the placenta. Placenta accreta, where part of the placenta is deeply embedded in the uterine wall, can be another reason a woman has a retained placenta. Women who have experienced this complication in previous labors are also likely to re-develop a retained placenta.
Sometimes the whole placenta is left inside the uterus and in other cases only part of it is delivered. The risks or a retained placenta are twofold. First, the woman may bleed, sometimes very heavily, because the uterus does not contract and returns to normal size. Secondly, women are at risk of uterine infections caused by the rupture of placental material left inside the uterus.
Signs of a retained placenta are usually obvious to a doctor. Depending on a woman’s birth plan, the interventions recommended or offered may vary. Women undergoing managed labor may be given drugs to stimulate contractions and expel the placenta, for example, while women seeking natural childbirth may be encouraged to breastfeed immediately, as this sometimes triggers contractions, or to take of herbs. If the placenta cannot be delivered after these minimally invasive surgeries, a midwife or doctor will need to enter the uterus to extract it.
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