placenta (retention)
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'Retained products' is where all or part of the placenta or membranes are left behind in the uterus during the third stage of labour. Most commonly this is a succinate lobe of the placenta, which underlines the importance of a thorough examination of the placenta after childbirth - a vessel in the membranes apparently leading to nothing is a sinister sign.

Retained placenta can be broadly divided into:

  • failed separation due to failure of uterine contraction or morbid adherence e.g. to a fibroid or scar
  • separated but retained due to e.g. a snapped cord contracted uterus, closed cervix

Retained placenta is a common cause of postpartum haemorrhage, both primary and secondary.

Treatment of women with a retained placenta (1):

  • intravenous access should always be secured in women with a retained placenta
  • intravenous infusion of oxytocin should not be used to assist the delivery of the placenta
  • for women with a retained placenta oxytocin injection into the umbilical vein with 20 IU of oxytocin in 20 ml of saline is recommended, followed by proximal clamping of the cord
  • if the placenta is still retained 30 minutes after oxytocin injection, or sooner if there is concern about the woman's condition, women should be offered an assessment of the need to remove the placenta. Women should be informed that this assessment can be painful and they should be advised to have analgesia or even anaesthesia for this assessment
  • if a woman reports inadequate pain relief during the assessment, the healthcare professional must immediately stop the examination and address this need
  • if manual removal of the placenta is required, this must be carried out under effective regional anaesthesia (or general anaesthesia when necessary).

Reference:

  1. NICE (September 2007).Intrapartum care.

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