Retained Placenta After Birth

The moments after delivery should bring relief and joy, but sometimes the birth process isn’t quite finished. When the placenta fails to come out on its own within 30 to 60 minutes after your baby is born, it creates a medical situation that needs immediate attention. This condition, known as retained placenta, affects between 1 in 100 and 1 in 200 vaginal deliveries and can lead to serious complications if not recognized and treated promptly.

Understanding what retained placenta is, why it happens, and how it’s managed can help you make sense of this unexpected turn during delivery. While it’s not common, knowing the warning signs and risk factors gives families the information they need to advocate for quick intervention when it matters most.

What Retained Placenta Means and How Often It Happens

Retained placenta occurs when all or part of the placenta stays inside the uterus instead of being delivered naturally after birth. Medical teams typically expect the placenta to come out within 18 to 60 minutes after the baby is born. If it doesn’t, or if heavy bleeding starts before the placenta delivers, doctors diagnose retained placenta and begin treatment.

This complication affects roughly 0.1% to 3% of all vaginal deliveries. The numbers vary based on several factors, including how far along the pregnancy was and whether certain risk factors are present. Preterm births, those happening before 37 weeks of pregnancy, see higher rates of retained placenta compared to full-term deliveries.

The condition requires immediate medical intervention because the uterus cannot contract properly and stop bleeding while placental tissue remains inside. What might seem like a minor delay can quickly become a life-threatening emergency without proper care.

Three Types of Retained Placenta and Why Each One Happens

Not all retained placentas occur for the same reason. Understanding the type helps doctors choose the right treatment approach.

Trapped Placenta

Sometimes the placenta actually separates from the uterine wall just as it should, but the cervix closes before the placenta can pass through. Think of it like a door closing before you can walk through it. The placenta has done its job of detaching, but now it’s stuck behind a closed cervix. This is often the easiest type to resolve because the placenta itself isn’t abnormally attached.

Adherent Placenta

In this situation, the placenta simply refuses to let go of the uterine wall. The normal separation process that should happen after birth doesn’t occur because the placenta has attached more firmly than it should have. Without that natural separation, the placenta stays put even when the cervix remains open. This type often requires manual removal by a doctor.

Placenta Accreta Spectrum

This is the most serious type and represents abnormal placental attachment where the placenta grows too deeply into the uterine wall. Instead of attaching to the surface lining of the uterus as it should, the placenta invades into the muscle layer or sometimes even through the entire uterine wall. This happens more often in women who have had previous cesarean sections or other uterine surgeries because scar tissue changes how the placenta attaches. In severe cases, a hysterectomy may be necessary to stop life-threatening bleeding.

Risk Factors That Make Retained Placenta More Likely

Certain circumstances increase the chances of experiencing retained placenta. Being aware of these factors helps medical teams prepare and respond quickly if complications arise.

Previous Pregnancy and Birth History

Women who have given birth multiple times face higher risk than first-time mothers. Having had a retained placenta in a previous pregnancy also significantly increases the likelihood it will happen again. Previous uterine surgeries, including cesarean sections and dilation and curettage procedures, create scarring that interferes with normal placental attachment and separation.

Current Pregnancy Characteristics

Preterm births carry elevated risk for retained placenta. Pregnancies conceived through in vitro fertilization also show higher rates of this complication. Stillbirth deliveries present additional risk factors that medical teams monitor carefully. Congenital uterine anomalies, or structural differences in the shape or formation of the uterus, can affect how the placenta attaches and releases.

Labor and Delivery Factors

Prolonged use of oxytocin during labor, a medication given to strengthen contractions, has been linked to increased risk of retained placenta. The medication helps move labor along, but extended use may affect how the placenta separates after birth.

Medical providers typically review your history during prenatal care to identify these risk factors early. When risks are known ahead of time, the care team can prepare appropriate resources and respond more quickly if complications develop.

How Retained Placenta Causes Dangerous Bleeding After Delivery

Postpartum hemorrhage, or excessive bleeding after childbirth, ranks as one of the most serious complications of retained placenta. In fact, retained placenta is the second leading cause of significant and potentially fatal bleeding following delivery.

The connection between retained placenta and hemorrhage is straightforward but critical to understand. After the baby is born, the uterus needs to contract and tighten to close off the blood vessels where the placenta was attached. Picture wringing out a towel: the twisting motion closes off openings and stops liquid from flowing out. The uterus works the same way, using strong contractions to clamp down on those blood vessels.

When placental tissue remains inside the uterus, it physically prevents the uterus from contracting properly. Those blood vessels stay open and continue bleeding. The numbers tell a stark story about this risk. Women with retained placenta face up to 33 times higher odds of losing more than 500 milliliters of blood compared to women whose placentas deliver normally. That’s more than two cups of blood, enough to cause serious symptoms and medical consequences.

The need for blood transfusion jumps dramatically with retained placenta. Studies show that 13% of patients with retained placenta require transfusion, compared to essentially 0% in women without this complication. Blood transfusions themselves carry risks and require careful monitoring, adding another layer of medical intervention to an already complicated situation.

Without quick recognition and treatment, this bleeding can escalate to life-threatening levels within minutes. Medical teams must act fast to remove the placental tissue and help the uterus contract properly to stop the bleeding.

Infection Risk When Placental Tissue Stays Inside the Uterus

Beyond immediate bleeding concerns, retained placenta creates conditions ripe for infection. The uterus after delivery is essentially an open wound where the placenta was attached. Normally, once the placenta delivers and the uterus contracts, this wound begins healing quickly. But when placental tissue remains inside, it acts like a foreign object that encourages bacterial growth.

Endometritis, an infection of the uterine lining, develops more frequently in cases of retained placenta. The retained tissue provides a place for bacteria to multiply and spread throughout the uterine cavity. Signs of endometritis include fever, foul-smelling discharge, abdominal pain, and feeling generally unwell in the days after delivery.

Manual removal of the placenta, while necessary to prevent hemorrhage, further increases infection risk. The procedure involves a doctor placing a hand inside the uterus to separate and extract the placenta. This necessary intervention introduces additional opportunity for bacteria to enter the uterine cavity, even when performed under sterile conditions.

Antibiotics may be given prophylactically to reduce infection risk, though research on their effectiveness in this specific situation shows mixed results. The decision to use preventive antibiotics depends on individual circumstances and the clinical judgment of your care team.

Infections caught early typically respond well to antibiotic treatment, but unrecognized or untreated infections can spread beyond the uterus and cause serious systemic illness. This is why medical teams monitor patients closely after manual placenta removal, watching for any signs of developing infection.

How Retained Placenta Affects Hospital Stay and Recovery Time

The physical and logistical impacts of retained placenta extend beyond the immediate complication. Women who experience retained placenta typically face longer hospital stays than those with uncomplicated deliveries.

Manual removal of the placenta requires anesthesia, often spinal or epidural if you don’t already have pain relief in place. The procedure itself adds time and medical intervention to your immediate postpartum period. Instead of focusing on your newborn and beginning recovery, you’re undergoing an additional medical procedure with its own set of risks and recovery considerations.

Monitoring continues more intensively after retained placenta. Medical teams watch for signs of ongoing bleeding, infection, and other complications. This extra surveillance means more frequent vital sign checks, additional blood tests, and closer observation that can feel intrusive during what should be a special bonding time with your baby.

Some women require readmission to the hospital days or weeks after going home if retained tissue wasn’t completely removed during the initial procedure or if delayed complications develop. These readmissions disrupt the already challenging newborn period and create additional stress for the entire family.

Recovery from manual placenta removal takes longer than recovery from normal delivery alone. The uterus has experienced additional trauma from the procedure, and you may have more cramping, discomfort, and bleeding than expected. Physical healing happens alongside emotional processing of an unexpected and frightening complication.

Long Term Effects Including Fertility Concerns

Most cases of retained placenta, while serious in the moment, don’t cause permanent damage once properly treated. However, some situations do carry long-term implications that affect future pregnancies and fertility.

The most severe cases involving deep placental invasion, known as placenta accreta, increta, or percreta, sometimes require hysterectomy to control bleeding and save the mother’s life. When the entire uterus must be removed, permanent infertility results. This outcome represents the most devastating long-term consequence of retained placenta, though it’s reserved for the most serious cases where other interventions have failed or aren’t possible.

Women who have experienced retained placenta face increased risk of the same complication in future pregnancies. This doesn’t mean it will definitely happen again, but the history puts you in a higher-risk category that warrants closer monitoring and preparation during subsequent deliveries.

Uterine scarring from manual placenta removal or surgical intervention can affect how the placenta attaches in future pregnancies. This scarring increases the risk of placenta accreta spectrum disorders if you become pregnant again, creating a cycle where one complication raises the odds of more serious complications later.

Delayed hemorrhage occasionally occurs when small fragments of placental tissue are missed during initial treatment. This retained tissue can cause sudden, heavy bleeding weeks after delivery, requiring emergency care and sometimes surgical intervention. This delayed bleeding is unpredictable and frightening, happening when you thought the danger had passed and you were safely into the recovery period.

Warning Signs That Placenta Delivery Is Taking Too Long

Recognizing the signs of retained placenta quickly allows for faster intervention and better outcomes. Both medical teams and patients should be aware of what’s normal and what signals a problem.

The most obvious sign is simply time. If 30 minutes pass after your baby’s birth and the placenta hasn’t delivered, your medical team will begin taking action. Some providers wait up to an hour before intervening if there are no other concerning signs, but anything beyond that timeframe definitely requires intervention.

Heavy vaginal bleeding before the placenta delivers serves as a red flag that something isn’t right. Some bleeding is normal, but soaking through pads quickly or passing large clots indicates excessive blood loss that needs immediate attention. This bleeding happens because the uterus cannot contract properly while placental tissue remains attached.

Your provider can also assess the situation by gently pulling on the umbilical cord while applying counter-pressure to your abdomen. If the placenta is separated and ready to deliver, this controlled cord traction helps it come out. If the placenta hasn’t separated or is abnormally attached, this maneuver won’t work, signaling the need for other interventions.

After delivery, if you experience symptoms like dizziness, rapid heartbeat, feeling faint, or excessive tiredness beyond normal postpartum fatigue, these may indicate significant blood loss from retained placenta even if you don’t see heavy visible bleeding. Always report these symptoms to your care team immediately.

Medical Treatment and Manual Removal Procedures

When retained placenta is diagnosed, treatment focuses on removing the tissue as quickly and safely as possible to prevent hemorrhage and infection. The specific approach depends on the type and severity of the situation.

Manual Removal of the Placenta

Manual removal is the most common treatment for retained placenta. This procedure requires adequate pain relief, typically through spinal, epidural, or sometimes general anesthesia if you don’t already have an epidral in place. The doctor carefully inserts a hand into the uterus and uses fingers to gently separate the placenta from the uterine wall, then removes all placental tissue.

The procedure sounds more frightening than it actually feels when performed with proper anesthesia. Most women feel pressure and tugging sensations but not sharp pain. The goal is complete removal of all placental tissue in one procedure to avoid the need for repeat interventions.

After manual removal, your provider carefully examines the placenta to ensure it’s intact and nothing remains inside. Even small fragments left behind can cause continued bleeding or later infection. Some providers also perform an ultrasound immediately after to confirm the uterus is empty.

Medication Approaches

Doctors sometimes try medications before resorting to manual removal, though these approaches work less reliably. Oxytocin or other uterotonic medications help the uterus contract and may encourage placental separation. Nitroglycerin can relax the cervix if a separated placenta is trapped behind a closed cervix.

These medical management attempts typically only work in specific situations and aren’t appropriate when heavy bleeding is occurring. Manual removal remains the definitive treatment in most cases.

Surgical Intervention

When manual removal fails or placenta accreta spectrum is diagnosed or suspected, surgical treatment becomes necessary. This might involve dilation and curettage to remove remaining tissue, or in severe cases with placenta accreta, hysterectomy to remove the entire uterus along with the abnormally attached placenta.

Surgical teams prepare for these possibilities when risk factors are known before delivery. Having blood products available and ensuring appropriate surgical and anesthesia staff are ready can be lifesaving in emergency situations.

How Medical Teams Prepare When Risk Factors Are Known

Prevention and preparation make a significant difference in outcomes when risk factors for retained placenta are identified during pregnancy. Proactive planning allows medical teams to respond instantly if complications develop rather than scrambling to gather resources during an emergency.

Prenatal care includes screening for risk factors like previous cesarean sections, history of retained placenta, or suspected placenta accreta. When high-risk factors are present, delivery planning changes significantly. You might be advised to deliver at a hospital with specialized resources rather than a birth center. Your delivery might be scheduled rather than waiting for spontaneous labor, allowing the team to have full staff and resources available.

Blood products should be immediately available for high-risk deliveries. Type and cross-matching your blood ahead of time means compatible blood units are ready for transfusion if hemorrhage occurs. This preparation can save critical minutes during a bleeding emergency.

Anesthesia teams stay close during delivery when retained placenta is anticipated. Quick access to additional anesthesia for manual removal procedures or emergency surgery makes intervention faster and safer.

Some high-risk patients undergo imaging studies like MRI during pregnancy to evaluate placental attachment more thoroughly. This information helps teams decide whether manual removal might be possible or whether more extensive surgical intervention will likely be necessary.

Communication matters enormously. When you understand your specific risk factors and the plan for managing them, you can advocate for yourself and make informed decisions if complications arise. Ask questions during prenatal care about your individual risk level and what preparations are being made.

What Recovery Looks Like After Retained Placenta Treatment

Physical recovery after retained placenta involves healing from both the delivery itself and the additional procedures required to remove the placenta. This doubled impact means recovery takes longer and requires more attention than after uncomplicated births.

Bleeding continues for several weeks after delivery, just as it would normally, but you may experience heavier flow or longer duration. Your provider will give you specific guidance on what’s normal versus what requires medical attention. Passing large clots, soaking through pads very quickly, or bleeding that suddenly increases after decreasing are all reasons to call your doctor immediately.

Pain and cramping may be more intense than after uncomplicated delivery. The uterus has undergone trauma from manual removal or surgical procedures, creating additional soreness as it heals and contracts back to its normal size. Pain medication prescribed by your provider helps manage this discomfort while allowing you to care for your baby.

Follow-up appointments become even more critical after retained placenta. Your provider will want to see you sooner and possibly more frequently than the standard postpartum schedule. These visits include checking your physical healing, watching for signs of infection, and monitoring your emotional recovery.

Physical activity restrictions may be more stringent after retained placenta. While normal postpartum care advises avoiding heavy lifting and strenuous activity, these restrictions might last longer or be more strict when you’ve had complications. Listen to your body and don’t push yourself to “bounce back” quickly.

Emotional recovery deserves equal attention to physical healing. Experiencing a scary complication during what should be a joyful time affects you psychologically. Some women struggle with anxiety, hypervigilance about their health, or symptoms of postpartum post-traumatic stress. These responses are valid and treatable. Mental health support is just as important as physical follow-up care.

Questions to Ask Your Healthcare Provider About Retained Placenta Risk

Open communication with your healthcare team helps you understand your individual risk and feel more prepared for delivery. Consider asking these questions during prenatal visits, especially if you have known risk factors.

If you’ve had previous cesarean sections or uterine surgeries, ask specifically about your placenta’s location and whether imaging shows normal attachment. Understanding whether your placenta is positioned over old scar tissue helps gauge risk for accreta spectrum disorders.

Find out what resources are available at your planned delivery location. Does the hospital have blood bank access 24/7? Is there an operating room immediately available if surgical intervention becomes necessary? Are providers experienced in managing retained placenta on staff at all times? These logistics matter if complications arise.

Discuss the plan for your specific situation. If you have multiple risk factors, what preparations are being made? At what point would manual removal be attempted? What are the criteria for moving to surgical intervention? Understanding the decision-making process helps you know what to expect.

Ask about signs and symptoms you should watch for after delivery, both in the hospital and after going home. Knowing exactly when to seek help empowers you to advocate for yourself if problems develop. Get clear instructions on who to call and when, including nighttime and weekend contacts.

If you’ve had retained placenta before, discuss how this history affects your current pregnancy and delivery planning. Will interventions be different this time? Are there preventive measures that might help? Understanding how past experience informs current care reduces uncertainty.

Moving Forward After a Retained Placenta Experience

Experiencing retained placenta changes how you view childbirth and can affect decisions about future pregnancies. Many women feel anxious about whether this complication will happen again or worry about more serious problems in subsequent births. These concerns are completely understandable and deserve thoughtful consideration.

If you’re planning another pregnancy, discuss your history thoroughly with your provider early in prenatal care. That previous retained placenta puts you at higher risk for recurrence, which means your care team will monitor you more closely and prepare differently for your delivery. This increased vigilance is protective, not alarming. Early planning and preparation improve outcomes significantly.

Processing the emotional impact of a complicated delivery takes time. Some women benefit from talking through their birth experience with a counselor who specializes in birth trauma or perinatal mental health. Others find peer support groups helpful for connecting with people who understand what they went through. Don’t minimize your experience or feel you should “just be grateful everyone is okay.” Both things can be true. You can be thankful for a healthy baby while also acknowledging that what happened was frightening and difficult.

Understanding what happened and why helps many families make sense of the experience. Ask your provider for a detailed explanation of what occurred during your delivery, why the retained placenta happened if a cause could be determined, and what interventions were necessary. This debriefing conversation can answer lingering questions and provide closure. Knowledge reduces fear and helps you feel more in control if you face childbirth again.

Physical recovery eventually completes, but the memory and emotional impact may linger longer. Give yourself permission to heal at your own pace, both physically and emotionally. Retained placenta is a serious complication that required medical intervention to keep you safe. Acknowledging the reality of what you went through isn’t dwelling on negativity. It’s validating your own experience and giving yourself the space to process and heal completely.