#Pregnancy and Infant loss Awareness Month- Retained Placenta- Causes, Type, Symptom and Treatment

October is Pregnancy and Infant Loss Awareness month. According to Wikipedia, the pregnancy and Infant Loss Awareness month began in the USA in the year 1987. it is a national tribute to those who suffered from a miscarriage, stillbirth or infant loss due to SIDS, prematurity or other causes.

To make this month meaningful and support this Nobel motive, from my side, I am trying to share some common pregnancy complications, their treatment and prevention factors on my blog during this month.

And as a first post, I am sharing one of the common pregnancy complication “Retained Placenta”

What is Retained placenta? whar are types, sign-symptoms, risk factors? and what are treatment and prevention options? read on to know more!

During Pregnancy your body goes through many emotional and psychological changes. Placenta formation is one of them. The placenta is an important organ which begins to form in week 4 of pregnancy. It is a circular vascular organ in the uterus of pregnant mammals, nourishing and maintaining the foetus through the umbilical cord. Normally placenta and foetal membrane expelled from the uterus after the birth of the baby. Placental expulsion is associated with the third stage of labour.”

The third stage of labour has two type of management option.

• Physiological
• Managed third stage

1. In physiological third stage, uterus naturally starts to contract again after the birth of a baby and this makes the placenta detach from the wall of the uterus. In managed third stage (usually in case of high-risk pregnancy) certain medication like oxytocin is used. The medication helps the uterus to contract down and push out the placenta and membranes.
2. In physiological third stage, the placenta may take up to 1 hour to come out and in the managed third stage it usually comes out within 30 minutes of your birth of the baby. If a placenta does not come out within this span of time (according to the selected stage) then it will be called a retained placenta. According to Wikipedia,

“In humans, a retained placenta is generally defined as a placenta that has not undergone placental expulsion within 30 minutes of the baby’s birth where the third stage of labour has been managed actively.”

Epidemiology

in less developed countries, it affects about 0.1% of deliveries but has up to 10% case fatality rate. In more developed countries it is more common in the case of vaginal deliveries but very rarely associated with mortality but it is a major cause of post-partum haemorrhage.

Aetiology or causative factors:

The causative factors can be divided in to:

• Uterine causes
• placental causes
• Other causes

Uterine causes– uterine atony (a condition in which uterus does not contract enough to separate the placenta from the wall of the uterus) is a major cause of retained placenta. Occasionally, other uterine abnormalities like bicornuate uterus may be associated with it.

Placental causes– there may be three types of abnormalities in the placental attachment. These are called Placenta percreta, Placenta accreta, Placenta increta. In these conditions, placenta attaches itself too deeply into the wall of the uterus. And depending on the severity and deepness condition is called placenta accreta, placenta increta or placenta percreta.

Sometimes a detached placenta is trapped behind a closed cervix, and then it is called a trapped placenta. And when myometrium behind the placenta fails to contract and placenta remain attached to the uterine wall for an abnormally long time following birth, the condition is called placenta adherens.

Other causes- full bladder and the strong emotional reaction may cause retained placenta in some cases.

Risk factors

• Previous history of retained placenta
• Previous injury or surgery to the uterus
• Preterm labour
• Pregnancy-associated with hypertension
• Induced labour
• Multiparity

Sign and symptoms

the most obvious sign of retained placenta is that failure of all or part of the placenta to come out from the body within an hour after delivery. If a placenta remains in the body, women will experience following symptoms the day after delivery. It may be:

• Heavy bleeding
• Severe pain
• Foul smelling discharge
• Tummy cramps
• A lack of breast milk

Diagnosis

usually, diagnosis is made on the symptomatic basis. If your doctor suspects that it is a case of retained placenta, he may perform a USG test for confirmation. Transvaginal sonography is slightly superior in this examination, due to its higher resolution.

Management

General

• Emptying the bladder
• Change the position encourages an upright position.
• Breastfeeding or nipple stimulation to promote uterine contraction.

Manual removal of placenta

this is the most common practice to remove the placenta. The doctor may be able to remove retained placenta manually. It is usually carried under anaesthesia. There are two indications for this method. First, if the sudden occurrence of haemorrhage but the placenta gives no indication of delivering and second if after the birth examination of placenta shoes missing placental fragments.  But this method carries an increased risk of infection.

Dilatation and curettage- it is the second method to treat retained placenta. Dilation refers to the opening of the cervix and curettage refers to the removal of tissues from the uterus through the scrapping under proper medication.

Complication

• life-threatening like shock (hypovolemic)
• Postpartum haemorrhage
• Puerperal sepsis
• Hysterectomy
• Uterine inversion

Alternative treatment

Homeopathic approach- although homeopathic remedies work on the principle of “individualization” means any remedy can be prescribed on the basis of individual symptoms and may provide an ideal cure. Still, there are certain remedies that can work great in the retained placenta.

• Preventive medicine– Arnica is the best remedy that should be used at the beginning of and hourly throughout the labour. A dose of arnica 200 can be given to mother after the childbirth to minimize the pain and to improve muscle control. It is also helpful in the prevention of post-partum haemorrhage.
• Female remedies– Sepia, Pulsatilla and cimicifuga are main female remedies that can be used according to symptoms similarities. For example:
• Sepia- most useful for women who have had many babies and feeling extremely exhausted during labour with violent bearing down pain as if everything comes out. Mentally she is sad, irritable and indifferent to everything.
• Pulsatilla- when characteristic yielding disposition and desire for consolation. It is the good remedy when there are malposition baby and history of constipation and haemorrhoids in pregnancy.
• Cimicifuga- when there is the irregular but painful contraction. This remedy helps to dilate the cervix. Mentally patient is sensitive to noise and irritable. Worse from a cold.
• Cantharis- it is another good remedy that has expulsive action. Strong desire to urinate but only a few drops are passed with burning and cutting pain is the most characteristic symptom.
• Anti-haemorrhagic remedies- like phosphorus, milifolium, secal cor can be used to control post-partum haemorrhage according to symptoms similarity.

Although “prevention is always better than cure” but unfortunately in case of retained placenta, there is no fixed preventive measures. If you have retained placenta in previous pregnancy there are chances of recurrence is higher in next pregnancy also. The best thing is that if you have retained placenta in the previous pregnancy or had any other risk factors (preterm labour, stillbirth or hypertension) inform your doctor about it, so he can try to manage your third stage of labour effectively with proper medication to prevent the recurrence and other complications.

So moms if you had any risk factors, do not afraid. Follow a healthy lifestyle and these guidelines. You would be able to get the biggest gift of God with tears of happiness in eyes. If you had a heartfelt pregnancy story do not forget to share with us. Until then Happy parenting!