What Is a Retained Placenta?

The placenta is a temporary organ that grows during pregnancy to filter oxygen, blood, and nutrients to your baby. After you give birth, you will also deliver your placenta shortly after.

Sometimes all or part of the placenta stays in the womb. This is called a retained placenta and it can have serious side effects.

Causes of a Retained Placenta

After your baby is born, you will usually deliver your placenta within 18 to 60 minutes. Your uterus contracts, which pulls the placenta away from the wall of your uterus and pushes it out. Sometimes this doesn’t happen and can be caused by different things, including:

  • Not enough contractions
  • The placenta grows into the uterus wall
  • The cervix closes
  • Early delivery
  • Giving birth many times
  • Previous surgery in the uterus
  • Conceiving by in vitro fertilization
  • Having a retained placenta in another pregnancy
  • Being born with uterus deformities
  • Having oxytocin medication for too long

The most common reason for a retained placenta is not enough contractions in the uterus. Contractions can slow down or the uterus can have trouble contracting for different reasons. These include:

Symptoms of a Retained Placenta

The most obvious sign of a retained placenta is that you don’t deliver it. The most common symptom of a retained placenta after birth is sudden blood loss and life-threatening bleeding.

At times you might push out most of it, however, some pieces of the placenta can be stuck inside. This can cause symptoms that take a while to show up such as:

If you have heavy bleeding and blood clots at home, make sure to keep your pads and show them to your doctor right away. They may want to check for placenta tissue.

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Risks of a Retained Placenta

Most women safely deliver the placenta after having a baby, but sometimes it can stay inside the womb. This can cause serious side effects.

Life-threatening bleeding. If your placenta is not delivered, it can cause life-threatening bleeding called hemorrhaging. 

Infection. If the placenta, or pieces of the placenta, stay inside your uterus, you can develop an infection. 

A retained placenta or membrane has to be removed and you will need to see your doctor right away. If you have major bleeding, this is a medical emergency and you should go to your nearest hospital immediately. 

Treatment for Retained Placenta

Some conditions can make it more likely that your uterus won’t contract properly. This can lead to a retained placenta. Your doctor will carefully check your medical history and consider how many births you’ve had and what kind of births. They might make plans during your pregnancy that can help ensure you won't have a retained placenta or prepare for retained placenta treatment.

Your doctor or midwife will also usually ask you to do a few things right after giving birth that can help prevent a retained placenta.

Breastfeeding. Your doctor, midwife, or nurse will likely ask you to start breastfeeding your baby as soon as possible after you give birth. This is because breastfeeding makes your uterus contract and is a natural process that will help prevent a retained placenta.

Changing positions. Your doctor might ask you to roll to the side or to squat. Changing positions can help your uterus contract and push out your placenta.

Massage. After delivery, your doctor might massage your abdomen to help it contract. This can feel uncomfortable but can be helpful. Abdominal massage is often used after your second birth. This is because your uterus might not contract very well if you’ve had several births. 

Medication. If these methods don’t work, your doctor might give you a shot of medicine that will make the uterus contract and help you deliver your placenta.

Manual removal. If your doctor diagnoses you with a retained placenta, they may want to remove the placenta by hand. They will often try another method first. Your doctor will give you an epidural or anesthetic medicine and manually separate the placenta inside the uterus.

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Surgery. If massage, medication, or other options don’t work, your doctor might decide to do surgery. You will have an operation to safely remove the placenta. If the placenta has grown into the uterus wall and invaded other tissues, you may need to have your uterus removed. 

Having surgery or a manual placenta removal can have risks, including infection and life-threatening bleeding. It can also cause endometritis, which is inflammation in the uterine lining. Your doctor may give you antibiotics to help stop infection and endometritis. 

A retained placenta is not very common, but it can happen. Part of giving birth to a baby is also pushing out your placenta and your doctor will closely watch for it to come.

WebMD Medical Reference Reviewed by Dan Brennan, MD on March 11, 2021

Sources

SOURCES:

International Journal of Women’s Health: “Retained placenta after vaginal delivery: risk factors and management.”

National Health Service St Helens and Knowsley Teaching Hospitals: “Manual Removal of the Placenta (afterbirth).”

National Health Service: “What complications can affect the placenta?”

StatPearls Publishing: "Uterine Atony."

University of Michigan Health: “5 Placenta Issues Every Woman Should Know.”

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