Understanding Placental Retention
Retained placenta is a condition when the placenta or placenta does not come out by itself or is retained in the uterus after giving birth or a condition where the placenta does not come out within 30 minutes after giving birth to the baby. This disorder is a rare complication that only affects about 2 to 3 percent of all births that occur. This condition is very dangerous because it can cause infection, even death. The placenta is an organ that forms in the uterus when pregnancy begins. This organ functions as a provider of nutrients and oxygen for the fetus, as well as a channel for removing metabolic waste from the fetus’ blood.
Normally, the placenta comes out of the uterus by itself a few minutes after the baby is born. However, in mothers who experience retained placenta, the placenta does not leave the uterus until after 30 minutes after delivery.
Causes of Retained Placenta
Based on the cause, retained placenta is divided into several types, namely:
- Placenta adherens.
Placenta adherens type of retained placenta occurs when uterine contractions are not strong enough to expel the placenta. This condition can be caused by maternal fatigue after giving birth or due to uterine atony. Placenta adherens is the most common type of retained placenta. - Placenta accreta.
Placenta accreta occurs when the placenta grows so deep in the uterine wall that uterine contractions alone cannot expel the placenta. This condition is generally caused by abnormalities in the lining of the uterus due to surgery on the uterus or caesarean section in a previous pregnancy. - Placenta increta.
The placenta is implanted throughout the muscle layer of the uterus. - Incarcerated placenta.
Retention of the placenta due to narrowing of the cervix. - Trapped placenta.
Trapped placenta is a condition when the placenta has separated from the uterine wall, but has not yet left the uterus. This condition occurs due to the closure of the cervix before the placenta comes out.
Risk Factors for Retained Placenta
Placental retention is more at risk for mothers due to the following factors:
- Get pregnant at the age of 30 years and over.
- Giving birth before the gestational age reaches 34 weeks (premature birth).
- Experiencing a labor process that is too long.
- Giving birth to a dead baby in the womb.
- Have a history of previous caesarean section.
- Have uterine abnormalities.
- Have a history of retained placenta in a previous delivery.
- Long time difference between first and second birth.
Symptoms of Retained Placenta
The main sign of placental retention is the retention of part or all of the placenta in the body for more than 30 minutes after the baby is born. Other complaints that can be experienced are:
- Chills or chills.
- Long-lasting cramps and pain.
- Having a fever.
- Discharge and unpleasant-smelling tissue from the vagina.
- Heavy bleeding.
- Formation of blood clots.
- Have an infection.
Immediately go to the hospital or obstetrician if a pregnant woman experiences signs of giving birth, such as contractions or rupture of the amniotic fluid. Giving birth in a hospital or under a doctor’s supervision can reduce the risk of placental retention. For pregnant women who do not give birth in a hospital or give birth without medical supervision, be aware of the complaints above. If the placenta does not come out until 30 minutes after giving birth, seek medical attention immediately.
Diagnosis and Treatment of Retained Placenta
The diagnosis of retained placenta is made immediately when the placenta does not come out until 30 minutes after the baby is born. Apart from that, the patient can also be said to have retained placenta if the placental tissue that comes out of the uterus is not intact.
Treatment for retained placenta aims to remove the placenta or remaining placental tissue from the uterus. Actions taken by doctors include:
- Removing the placenta from the uterus manually (using hands).
- Giving drugs to stimulate the uterus to contract and expel the placenta, for example oxytocin or methylergometrine.
If the patient’s condition is stable, the doctor may advise the patient to urinate frequently because a full bladder can prevent expulsion of the placenta. The doctor will also advise the patient to breastfeed immediately because this process can trigger uterine contractions and help the placenta to come out. If all the methods above are unsuccessful in removing the placenta from the uterus, the doctor will perform a surgical procedure as a last resort.
Complications of Retained Placenta
Retained placenta causes the blood vessels attached to the placenta to continue to open and bleed. This condition causes postpartum bleeding which can threaten the patient’s life.
Other complications that can occur are:
- Uterine infection or endometritis.
- Uterine subinvolution, which is a condition when the uterus does not return to its normal size after giving birth.
- Placental polyps or abnormal tissue growth in the placenta.
Prevention of Retained Placenta
To prevent placental retention, the doctor will take anticipatory steps during the delivery process, such as:
- Giving medication, such as oxytocin, immediately after the baby is born to stimulate uterine contractions so that the entire placenta comes out.
- Carrying out a controlled cord traction (CCT) procedure, namely clamping and pulling the baby’s umbilical cord while giving a light massage to the mother’s stomach to stimulate uterine contractions.
Apart from that, pregnant women are also advised to undergo regular ultrasound pregnancy checks. Through this examination, the doctor can find out early on if the patient has risk factors that can trigger placental retention. That way, placental retention can be anticipated with thorough preparation for delivery.
