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Complications of retained placenta


I Wish I’d Known About the Risks of a Retained Placenta After Bir

Health and wellness touch each of us differently. This is one person’s story.

Around this time three years ago, I was preparing for the birth of my first child. I’d spent hours diligently researching birth and the wide range of birth-related questions. So, when I went into labor, I thought I’d done all I could to prepare for any event.

The birth had several obstacles.

I lost a lot of blood, received an episiotomy, and remained mildly conscious as my son was removed with forceps.

What I remember the most — other than my mother’s horrified face because my blood was slow to coagulate — was the pain. When my placenta came out in pieces, it seemed less important at the time. But it significantly shaped my introduction to motherhood.

Little did I know then, it would take over a month and a half to be diagnosed with retained placenta. I’d experience weeks of pain as a consequence of my placenta not being expelled at once.

“If the placenta or a part of the placenta does not spontaneously deliver within 30 minutes after the baby has delivered, a retained placenta is diagnosed. Normally the placenta will separate and deliver from the uterus on its own once the baby has been born,” explains Sherry Ross, MD, OB-GYN.

According to Ross, a retained placenta is rare but dangerous, and affects just 2 percent of all deliveries.

1. Placenta adherents happens when the placenta doesn’t separate spontaneously from the uterus within 30 minutes of the baby being born. This is the most common type of retained placenta.

2. A trapped placenta happens when the placenta separates from the uterus but doesn’t spontaneously leave the uterus.

3. Placenta accreta happens when the placenta grows into the deeper layer of the uterus and is unable to spontaneously detach from the uterus. This is the most dangerous type of retained placenta and can lead to needing a hysterectomy and blood transfusions.

Ross also notes that retained placenta during a C-section is likely placenta accreta, and can be dangerous and the most difficult to treat.

My research had prepared me for the intellectualization of birth-related pain. However, the reality was much worse.

It hurt to sneeze, pee, and I thought I would die during each doctor’s checkup to see if my uterus deflated.

Sadly, research couldn’t prepare me for the physical experience. And my introduction to birth-related pain had only begun.

At first, I was too concerned with my son’s health and the troubles he was having with keeping food down to worry about how I felt.

Any parent who has ever had a child in the NICU for any amount of time will tell you that everything else in the world stops mattering. Your only concern becomes how to help your baby — despite often being powerless.

Thankfully, my son was cleared to come home after 5 days. For the first time in nearly a week, I was present in my body, not just my mind. And being present in my body hurt much more than I expected.

I was so distracted by the adjustment to motherhood that I was able to ignore my physical discomfort. Until it became too difficult to walk to get diapers.

In addition to extreme tiredness, I would experience intense bouts of abdominal pain at a moment’s notice.

I was three weeks postpartum and even though I had no knowledge of post-birth normalcy, an urge to push followed by lots of blood and large clots during a family outing let me know I needed to go to the emergency room.

But to my dismay, and despite informing them I was still passing large clots while being seen, the doctor declared my experiences a “normal part of the postpartum healing process.”

It didn’t matter what my initial postpartum checkup or the emergency room physician said — I knew something was wrong.

Each day post-birth, I felt progressively weaker instead of stronger

I was struggling so much that my relatives suggested I spend a few weeks in my hometown since my husband had returned to work. I was hesitant to leave my husband and travel with such a young baby. But I knew I couldn’t take care of a baby alone while my body was in such extreme pain.

I didn’t physically feel better there, but I had much more support. One day, I felt gross (pain and motherhood were a setback for self-care) and ambitiously tried to take a bath. The walk down the hall was too much for my body, and I started feeling faint. My son was nearby in his infant car seat but the pain intensified and I couldn’t reach him when he started crying.

I watched in horror as my bathwater became crimson from blood — I was passing clots again. And even though my son was less than 3 feet away, it might as well have been a mile.

Thankfully, my aunt returned shortly after and demanded we go to the hospital. I called the nurse line to inquire about my pain one more time and check that the visit would be covered by our insurance. I was told to go to the local emergency room.

I continued losing blood during the 5-hour wait to be seen in the ER, but the moment I was called back, the doctor knew something was wrong.

When my urine pregnancy test came back positive, I was immediately sent back from an ultrasound where I was diagnosed with retained placenta. I was put under anesthesia for a dilation and curettage (D & C), which is the procedure used to remove tissue left behind in the womb.

The rest was a blur.

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Unfortunately, thanks to my first birth experience, I’m at an increased risk for retained placenta if I have more children.

“Women who are high risk for a retained placenta include those who have had previous dilation and curettage (D & C), a premature delivery before 34 weeks, a stillborn, uterine abnormalities, or a long first or second stage of labor. If you have had a previously retained placenta, you are also at risk for having it again with future pregnancies,” Ross explains.

Because of this, it’s important to look out for the symptoms of retained placenta and advocate for yourself if you see them.

Signs of retained placenta “The most common sign of a retained placenta is when the placenta fails to deliver spontaneously after 30 minutes once the baby has been born. If pieces of the placenta have not delivered days or weeks after delivery, fever, persistent heavy bleeding with blood clots, cramping, pain, and a foul-smelling discharge may occur,” explains Ross.

I explained most, if not all, of those symptoms to a medical professional — so why wasn’t it caught sooner?

It could have been my race, considering the medical system has a long history of false beliefs relating to higher levels of pain tolerance for Black Americans. As a result, our discomfort is often overlooked.

It could have been my gender. Women regularly have their concerns ignored during birth. This mistreatment is one of many reasons things like birth trauma push women to opt out of multiple pregnancies due to the horrors of their first experiences.

And lastly, it could have been an intersection of these factors. The United States has the highest maternal mortality rates of any developed nation. While women of all races are at risk, Black women like myself are at a multiplied risk for complications and even death.

Through the experience, I felt ignored by my healthcare providers, and that hurt almost as much as my physical pain.

You may be at increased risk for a retained placenta if:


  • you’re over age 30
  • you give birth before the 34th week of pregnancy
  • you experience a prolonged first or second stage of labor
  • you have a stillbirth

I was lucky I got a diagnosis when I did. I was already over a month into motherhood and things could have easily gone differently.

“Complications of a retained placenta include heavy bleeding, infection, uterine scarring, blood transfusion, and hysterectomy. Any of these complications can lead to death if not diagnosed and treated quickly,” noted Ross.

Retained placenta made the adjustment to new motherhood even more difficult.

I was too fatigued to perform small tasks, like getting diapers from the other side of the room. The condition would also be seen as a potential cause for the breastfeeding challenges I was having — I wasn’t producing very much milk.

The experience robbed me of my earliest memories of first-time motherhood and left in their place flashbacks of physical pain. But more importantly, my experience greatly impacted my trust in the medical system.

No one should have to jump through that many hoops to get answers about their health.

But, still, being armed with knowledge about the signs of retained placenta might help you get the right treatment more quickly.

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Rochaun Meadows-Fernandez is a diversity content specialist whose work can be seen in The Washington Post, InStyle, The Guardian, and other places. Follow her on Facebook and Twitter.

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A retained placenta is when the placenta is not delivered within 30 minutes of the baby’s birth. It is a serious problem since it can lead to severe infection or life-threatening blood loss.

Retained placenta is not a common condition, but because it’s serious, it will need to be managed by a medical team.

What causes retained placenta?

A placenta can be retained if your contractions aren’t strong enough to expel it, or if the cervix closes and traps the placenta inside your uterus.

You are more at risk of a retained placenta if you are over the age of 30, have a premature baby or if your first and second stages of labour were very long. It can also happen if you have a fibroid or another problem with your uterus.

Many women will have an injection of syntocinon (a synthetic version of the hormone oxytocin), which not only helps deliver the placenta but also helps reduce the risk of postpartum bleeding. Having this injection is called ‘active management’. If the mother chooses not to have the injection, it is called ‘expectant management’.


What are the symptoms of retained placenta?

The main symptom of retained placenta is that the placenta doesn’t completely come out of the uterus after the baby is born. Another symptom can be bleeding before the placenta comes out.

If a piece of placenta is left behind, you may develop symptoms days or weeks after the birth. These may include:

  • fever
  • a bad smelling discharge from the vagina
  • heavy bleeding
  • large pieces of tissue coming out of the vagina
  • pain

What is the treatment for a retained placenta?

Sometimes retained placenta can be treated simply if you empty your bladder, change position and have the doctor or midwife gently pull on the umbilical cord.

If that doesn’t work, you will need a procedure to remove the placenta. You will be taken into surgery after the birth and given an epidural or anaesthetic so you don’t feel anything. Your doctor will use an instrument called a curette to scrape away the lining of the uterus.

While you’re waiting for surgery, the medical team will keep a close eye on you to check you're not bleeding heavily (postpartum haemorrhage). The procedure itself is quick, but you will need to be monitored for several hours after to make sure you are not bleeding.

If you do start to experience some of the symptoms mentioned above in the days and weeks after you have had your baby, it’s important to see your doctor immediately. It is not always obvious after the placenta has been delivered that some tissue may have been left behind and this can lead to infection and bleeding. If you are bleeding heavily after the birth, you will need surgery to investigate the cause.

Sources:
RANZCOG (Management of Postpartum Haemorrhage (PPH)), King Edward Memorial Hospital (Retained placenta), Women's and Newborn Health Westmead Hospital (The birth of your placenta), International Journal of Women's Health (Retained placenta after vaginal delivery: risk factors and management)

Learn more here about the development and quality assurance of healthdirect content.

Last reviewed: February 2020


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Related pages

  • Placenta complications in pregnancy
  • About the placenta

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