Retention of the placenta is a condition when the placenta or placenta does not come out by itself or is stuck in the uterus after delivery. This condition is very dangerous because it can cause infection, even death.
The placenta is an organ that forms in the uterus when pregnancy begins. This organ functions as a provider of nutrients and oxygen for the fetus, as well as a channel for removing metabolic waste from the fetal blood.
Normally, the placenta comes out of the uterus on its own a few minutes after the baby is born. However, in women with retained placenta, the placenta does not emerge from the uterus until more than 30 minutes after delivery.
Causes of Placental Retention
Based on the cause, retained placenta is divided into several types, namely:
Placenta adherens
Types of retained placenta placenta adherens It occurs when the uterine contractions are not strong enough to expel the placenta. This condition can be caused by fatigue in the mother after childbirth or due to uterine atony. Placenta adherens This is the most common type of retained placenta.
Placenta accreta
Placenta accreta occurs when the placenta grows so deep in the uterine wall that uterine contractions alone cannot expel the placenta. This condition is generally caused by abnormalities in the lining of the uterus due to undergoing surgery on the uterus or caesarean section in a previous pregnancy.
Trapped placenta
Trapped placenta is a condition when the placenta has separated from the uterine wall, but has not yet emerged from the uterus. This condition occurs due to the closing of the cervix (cervix) before the placenta comes out.
Risk Factors for Placental Retention
Retention of the placenta is more at risk experienced by the mother with the following factors:
- Pregnant at the age of 30 years and over
- Giving birth before the gestational age reaches 34 weeks (premature birth).
- Experiencing labor that takes too long
- Giving birth to a dead baby in the womb
Symptoms of Placental Retention
The main sign of retained placenta is retention of part or all of the placenta in the body more than 30 minutes after the baby is born. Other complaints that can be experienced are:
- Fever
- Shivering
- Pain that lasts a long time
- Heavy bleeding
- Discharge and foul-smelling tissue from the vagina
When to go to the doctor
Immediately go to the hospital or obstetrician if you experience signs of impending labor, such as contractions or rupture of the amniotic fluid. Delivering in a hospital or under the supervision of a doctor can reduce the risk of retained placenta.
For pregnant women who do not give birth in a hospital or give birth without the supervision of medical personnel, be aware of the complaints above. If the placenta does not come out until 30 minutes after delivery, seek medical attention immediately.
Diagnosis of Placental Retention
The diagnosis of retained placenta is made immediately when the placenta does not come out until 30 minutes after the baby is delivered. In addition, the patient can also be said to have retained placenta if the placental tissue that comes out of the uterus is not intact.
Placenta Retention Treatment
Treatment of retained placenta aims to remove the placenta or the rest of the placental tissue from the uterus. Actions taken by doctors include:
- Remove the placenta from the uterus manually (by hand)
- Give drugs to stimulate the uterus to contract and expel the placenta.
If the patient's condition is stable, the doctor may advise the patient to urinate frequently because a full bladder can prevent the placenta from expelling. The doctor will also advise the patient to breastfeed immediately because this process can trigger uterine contractions and help the placenta to come out.
If all of the above methods fail to remove the placenta from the uterus, the doctor will perform a surgical procedure as a last resort.
Complications of Placental Retention
Retention of the placenta causes the blood vessels attached to the placenta to continue to open and bleed. This condition causes postpartum hemorrhage which can be life threatening for the patient.
Other complications that can occur are:
- Uterine infection or endometritis
- Uterine subinvolution, which is a condition when the uterus does not return to its normal size after delivery
- Placental polyps or abnormal growth of tissue in the placenta
Prevention of Placental Retention
To prevent placental retention, the doctor will take anticipatory steps during the delivery process, such as:
- Giving drugs, such as oxytocin, immediately after the baby is born to stimulate uterine contractions so that the entire placenta is expelled
- Carrying out procedures controlled cord traction (CCT), namely by clamping and pulling the baby's umbilical cord while doing a light massage on the mother's abdomen to stimulate uterine contractions
In addition, pregnant women are also advised to undergo regular ultrasound examinations for pregnancy. Through this examination, the doctor can find out from the start if the patient has risk factors that can trigger placental retention. That way, placental retention can be anticipated with careful preparation for delivery.