Your placenta (or afterbirth) gives your baby nutrients as it is developing in your womb. After your baby is born, the placenta needs to be delivered. This is called the ‘third stage of labour’.
Up to three women in every 100 are diagnosed with a retained placenta. This is when some or all of the placenta remains in the womb.
How do I know my placenta is retained?
The placenta will usually come out about 30 minutes after birth of your baby if you have chosen to have an injection of a drug called oxytocin.
It can take about an hour for your placenta to come out if you have not had the injection.
If your placenta has not come out after this amount of time your midwife will diagnose a retained placenta.
Is a retained placenta a problem?
Your placenta needs to be removed as it can cause complications such as heavy bleeding. This is called a ‘postpartum haemorrhage’ or PPH.
Your midwife and doctor are skilled and experienced in treating a PPH and will be prepared for this wherever you give birth.
What happens next?
Your midwife or doctor will advise different ways of getting your womb to contract and the placenta to come out. This could include:
Helping you empty your bladder
Asking you to breastfeed your baby to release more of your body’s own oxytocin, which makes your womb contract.
Massaging your tummy which can help to contract the womb.
Asking you to change your position (for example, by moving to a sitting or squatting position).
Giving you an injection of oxytocin.
Your womb can become tired after a long labour with less effective contractions after the baby is born. Oxytocin helps to increase your contractions and speed up delivery of the placenta. Your midwife and doctor can advise you on whether they think you need the drug.
If this does not work they will discuss with you the removal of your placenta by hand. This would be performed by the obstetrician (a doctor who is a specialist in delivering babies). This is often performed in the theatre where there is everything ready that the doctor will need. Your midwife will come with you and it may be possible for your birth partner and baby to come as well. The midwife will talk you through each decision made and offer you choices.
Manual removal of the placenta
Your medical team will give you medication that will reduce the risk of heavy bleeding and keep your womb contracted. This is given through an intravenous cannula, a thin tube that is be inserted into a vein, typically in your hand or the crease of your arm.
You will be offered a vaginal examination to find out exactly where the placenta is. Some people find this uncomfortable, so you will be offered some pain relief. Tell the midwife or doctor if you are still in pain during the examination as they can stop and give you more medication.
You will be offered an epidural or spinal anaesthetic, which means you will be awake but you will not feel any pain.
The procedure happens manually (using the doctor’s hands). If the placenta is sitting in the cervix your obstetrician can pull it out through your vagina. If it is in your womb, they will detach the placenta from the wall with their fingers and gently pull it out.
There is a risk of infection, so you will be given antibiotics through the drip in your arm and prescribed more oral antibiotics to take for the next few days.
What if there is some placenta left behind?
Sometimes, despite the best efforts of your midwives and doctors, some placenta gets left behind.
If you develop any symptoms such as:
- heavy bleeding that does not seem to reduce fever
- a sore and tender tummy
- smelly vaginal discharge
- feeling sick or vomiting
- difficulty breathing
Contact your maternity unit or GP if you have any of these symptoms. You may need an ultrasound scan to check for fragments of placenta in your womb. If there is any left your doctor may refer you for surgery to remove it.
For most people, the placental tissue will often pass out of your vagina by itself and will look like a big clot. You may have tummy cramps before passing it out, and it can take a few days.
If you’re at home and you pass a clot, contact your maternity unit or midwife and let them know what has happened. They may want to visit you to make sure your womb has contracted fully.
Always contact your midwife or doctor if you are worried.
What causes a retained placenta?
You are at higher risk of a retained placenta in your pregnancy if you:
- have had a retained placenta before
- have a body mass index (BMI) of more than 35
- have had previous surgery on your womb
- have given birth more than five times before.
Sometimes a retained placenta is unexpected.
There are three main causes:
- The placenta is attached very deeply to the wall of the womb. (placenta accreta)
- After birth the womb does not contract enough for the placenta to be pushed out.
- The cervix begins to close after birth and your placenta remains inside.
Will I have a retained placenta for my next birth?
If you have experienced a retained placenta, you do have a higher risk of having one again. This does not mean it will definitely happen.
| Term | Description |
|---|---|
| Placenta Accreta | Placenta accreta is a rare (between 1 in 300 and 1 in 2000) complication of pregnancy. This is when the placenta grows into the muscle of the uterus, making delivery of the placenta at the time of birth very difficult. |