RETAINED PLACENTA

 Definition:

Retained placenta is a
condition in which the placenta
fails to be expelled within 30
minutes after delivery of the
fetus. The main cause is
defective decidual reaction
(decidua basalis) leading to
absence of line of cleavage
through the spongy layer.

 AETEIOLOGY
 Retention of separated
placenta:
 Atony of the uterus with failure of
expulsion of the separated
placenta.
 Contraction ring leading to hour
glass deformity of the uterus.
 Complete rupture of the uterus
with passage of the placenta to
the peritoneal cavity.
 AETEIOLOGY
 Retention of non-separated
placenta:
1) Atony of the uterus leading to
absence of shearing mechanism
needed for placental separation.
2) Defective placentation in which
the decidua basalis is either
absent or defective and so the
chorionic villi penetrate the
uterine muscles.
 Placenta accreta.
 Placenta increta.
 CLINICAL PICTURE
 Vaginal bleeding: occurs only if part or the
entire placenta is separated.
 Uterine atony: the uterus is lax
abdominally and if bleeding occurs it will
be severe.
 Severe shock : Retention of placenta more
than 2 hours may cause shock even in
absence of haemorrhage (Idiopathic
obstetric shock)
 Vaginal examination can detect:
 Hour- glass contraction
 Absence of plane of cleavage: placenta
 MANAGEMENT OF RETAINED
PLACENTA
1. Cases of uterine atony:
 Gentle abdominal uterine
massage: To stimulate uterine
contraction.
 Give ergometrin (I.M.): to ensure
contraction of the uterus.
 Brandt-Andrews maneuver:
(Controlled cord traction and
suprapubic pressure) to deliver the
placenta.
 Manual removal of the placenta:
under general anesthesia.
 MANAGEMENT OF RETAINED
PLACENTA
 Cases of contraction ring:
Give the patient deep general
anesthesia, and then do manual
removal of the placenta.
Manual Separation of the
Placenta
 MANAGEMENT OF RETAINED
PLACENTA
 Cases of adherent placenta
 In cases of simple adhesion or partial placenta
accreta; manual separation and removal of the
placenta is done.
 In cases of placenta complete accreta either:
 Abdominal Hysterectomy: as a life saving procedure
in cases with shock and severe hemorrhage,
especially multiparous patients.
 Rarely may we attempt removing the placenta by
morecellation.
 In young patients and in primigravidas; the
placenta may be left in situ to undergo
autolytic changes after cutting the cord short.
Antibiotics and thorough observation are
essential. Such a management is unsafe and
 MANAGEMENT OF RETAINED
PLACENTA
 In case of rupture uterus:
Laparotomy is performed after
administrating blood transfusion
and antishock measures. Placenta is
removed from the peritoneal cavity
and the uterus is either repaired (in
non extensive tears) to preserve the
patient's fertility, or removed by
subtotal hysterectomy, if rupture
was extensive with poor patient's
general condition.
 COMPLICATIONS OF RETAINED
PLACENTA
1. Shock: haemorrhagic or idiopathic
obstetric shock.
2. Postpartum hemorrhage.
3. Puerperal sepsis
4. Subinvolution of the uterus.
5. Retained parts of the placenta may later
form a placental polyp and give rise to
choriocarcinoma.
6. Complications of the method done to
deliver the placenta and complications of
anesthesia.