Retained placenta occurs in approximately 3% of vaginal deliveries in the developed world. The risk of postpartum hemorrhage increases to 20% in women who have retained placenta (Franke. D etal 2021). The third stage of labour is classified as the delivery of the placenta. In Australia if the placenta is not delivered after 30mins it is classified as retained placenta and your medical team must consider if manual removal is required.

Retained placenta can have three causes;

  1. The placenta remains attached to the uterine wall despite uterine contractions.
  2. The placenta is trapped behind a closed cervix
  3. Placenta accreta; abnormal placental implantation

Risk factor for retained placenta;

  • Previous retained placenta
  • Previous caesarean section
  • Maternal age over 35
  • Preterm labour
  • Induced labour
  • Multiparity
  • Previous uterine surgery
  • Infection
  • Preeclampsia

If the third stage of labour persists after 30minutes the risk of postpartum hemorrhage increases. Postpartum hemorrhage is a significant risk of maternal mortality in birth. Your medical team are trained to work through multiple treatments before a manual removal is considered.  However, if these first treatments fail and spontaneous delivery isn’t achieved the team will weigh the risks and benefits for the mother of manual removal of the placenta.

Manual removal of the placenta can be performed in the delivery room or an operating theatre under anesthetic. The main goal is to remove the entire placenta from the uterus to prevent infection and to control any postpartum hemorrhaging that may be occurring. Truly a lifesaving procedure.

To prevent the risk of infection antibiotics are administered shortly after the removal of the placenta. Mums should be aware in the coming weeks that if abnormal bleeding persists after 6 weeks postpartum, they should seek GP guidance as small remnants of placenta may still be attached to the uterus.

RANZCOG acknowledges that after a delivery that required the use of instruments, women may have trouble voiding and recommend that pelvic floor rehabilitation is encouraged to reduce urinary incontinence. Bump Fitness physiotherapists are trained in pelvic floor rehabilitation and treatments in urinary incontinence. Reach out today if you have any concerns with your pelvic floor health following your pregnancy.