Retained placenta

[alphaearly]

Hi,

I wonder if you can help. I had retained placenta with my second child (1st was c-section) and I lost nearly 3 litres of blood and had emergency surgery. I am considering a 3rd child and wondered what the risk involved would be regarding this?

Kind regards,
Melanie

[BirthAffinity]

I'm sorry to hear about your previous experience - it sounds like it must have been quite frightening and traumatic for you.

Retained placentas are not very common, and are usually very easy to manage safely. It happens when part or all of the placenta stays inside the womb, instead of coming away whole. If any if the placenta is left inside the womb it can cause infection, or may cause haemorrhage. Normally, when the placenta comes away, your womb contracts down very hard to stop any bleeding from where the placenta was previously embedded. If a piece of placenta remain in your womb, it stops it from clamping down so tightly and so you continue to bleed from where the placenta has come away.

The majority of retained placentas occur either due to the cervix clamping shut before the placenta has been fully expelled from your womb, or when the cord snaps or breaks when the Midwife or doctor tries to deliver placenta during active management of third stage (you are given an injection once the baby is born and the midwife / doctor pulls the placenta out for you, as opposed to a physiological third stage, where everything is left undisturbed and your body gently pushes the placenta out). You would normally be given a spinal anaesthetic, or if you already have a working epidural in place, this would be topped up. Once your pain relief was in place, any placenta left in your womb is gently removed by hand by the doctor in theatre. It is usually a very quick and simple procedure, and women usually recover very quickly with no lingering side effects.

Very rarely, a placenta can embed too deeply into the womb lining, preventing it from coming away properly and making it very difficult for the doctor to remove. This is a much more serious situation, but fortunately is very rare indeed.

Previous retained placenta and previous Caesarian section are all sited as potential risk factors for retained placenta in a subsequent pregnancy, although your actual risk may well depend on the reason behind your first retained placenta - if the cause was a snapped cord, then the chance of recurrence would be much lower than if it were due to the placenta being abnormally stuck to the womb. Most obstetricians advise active management of third stage (ie injection and doctor/ midwife pulls placenta out for you) if you have had a retained placenta previously, although there is no research to support this in reducing the chance if retained placenta to my knowledge - active management does help reduce the chance of haemorrhage, but has also been linked to an increased chance of retained placenta too.

I think that in your case, particularly as it sounds so severe, I would definately try to arrange a meeting with a midwife or obstetrician to go through your notes and discuss your individual risk, managements strategies etc for any subsequent pregnancy. Most hospitals do offer this now through a "listening service" or similar. Contact the maternity unit where you had your last baby and they should be able to point you in the direction of the appropriate people to talk through your experience.

I hope this helps - it isn't a "given" that you will have a similar complication in a future pregnancy at all, and recurrent retained placentas are rare, but I think it is also wise to just go through your own previous experience to work out what your individual chances are. Xx

[alphaearly]

Hi Lorraine,

Thank you so much for your reply. The cord was broken after 3 midwives tried to remove it for around 5 mins or so, but I don't know why it didn't come away whether it was imbeded or my cervix closed although I did have the injection. I will call the hospital and see if I can arrange to speak with someone.

Thank u again! xx