Retain Placenta

Subject: Midwifery II (Theory)

Overview

Retained placenta occurs when the third stage lasts longer than half an hour. The causes of the retained placenta are full bladder, atonic uterus, morbid adherent placenta, and placenta entirely separated but retained due to weak voluntary expulsive effort, particularly weariness and lengthy labor. Its care comprises emptying the bladder with a rubber catheter, and any bleeding during this period should be handled similarly to third-stage bleeding and in accordance with the condition of the placent.

Retained placenta occurs when the third stage lasts more than half an hour.

Causes

  • Full bladder
  • Retention caused by an atonic uterus
  • Placenta morbidly adherent
  • The placenta was entirely separated but retained due to insufficient voluntary expulsive effort, particularly tiredness and lengthy labor.
  • Constriction ring

Management

  1. During the 12-hour period following delivery, keep a close eye out for any signs of bleeding, whether visible or hidden and take note of any indicators of placental detachment.
  2. A rubber catheter should be used to empty the bladder.
  3. Any bleeding during this time should be treated as if it were in the third stage.
  4. Management is carried out in accordance with the status of the placenta, as follows:
    - separated,
    - un-separated,
    - complicated
  5. The placenta is separated and retained: controlled cord traction is used to express the placenta.
  6. Unseparated retained placenta: The placenta will be manually removed under general anesthetic.

References

  • patient.info/doctor/retained-placenta
  • Pathak, Sumita and Sochana Sapkota. A Textbook of Leadership and Management. Bhotahity, Kathmandu: Vidyarthi Pustak Bhandar, 2014
  • www.healthline.com › Pregnancy › Preparing for Delivery
  • bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-9-48
  • www.babycentre.co.uk › Pregnancy › Labour and birth › Labour complications
Things to remember
  • Retained placenta occurs when the third stage lasts more than half an hour.
  • Full bladder, atonic uterus, morbid adherent placenta, and placenta entirely separated but retained due to poor voluntary expulsive effort, particularly weariness and extended labor, are all causes of retained placenta.
  • Its care comprises emptying the bladder with a rubber catheter, and any bleeding during this phase should be handled similarly to third-stage bleeding and according to the condition of the placent.
Questions and Answers
  • Full bladder,
  • Retention due to atonic uterus,
  • Morbid adherent placenta,
  • Placenta completely separated but retained due to poor voluntary expulsive effort especially exhaustion and prolonged labour,
  • Constriction ring.

Management

  • During the ½ an hour period following delivery , keen observation needs for evidence of any bleeding revealed or concealed and note the signs of separation of placenta,
  • The bladder should be emptied using a rubber catheter,
  • Any bleeding during this period should be managed as in third stage bleeding,
  • The management is done according to condition of placenta as;
    • Separated,
    • Un-separated,
    • Complicated.
      • Placenta is separation and retained : express placenta by controlled cord traction.
      • Unseparated retained placenta : manual removal of placenta is to be done under general anesthesia.

© 2021 Saralmind. All Rights Reserved.