postpartum retained placental fragments defined

Postpartum retained placental fragments defined manual#

We hereby report a case of retained placenta diagnosed in the third stage of labor and treated with several uterotonics, including misoprostol, oxytocin (Pitocin), carboprost (Hemabate), tranexamic acid, and ultrasound-guided suction curettage.Ī 32-year-old female, gravida 4 para 3, presented at 39 weeks and 4 days (dated by last menstrual period and first-trimester ultrasound) for induction of labor. It is therefore important to continuously research ways to adequately treat retained placenta and to review existing literature on the current treatment used in various healthcare settings. The retained placenta has a case mortality rate of nearly 10% in rural areas and should be diagnosed and treated early to avoid potentially fatal complications. Morbidity and mortality from adherent placenta and subsequent postpartum hemorrhage are higher in underdeveloped countries and in hospitals without adequate medical equipment to handle high-risk cases. However, it can be life-threatening when the placenta is morbidly adherent to the uterus.

Postpartum retained placental fragments defined manual#

Retained placenta can be benign (removed via manual extraction or curettage, as in our case report). Although most placenta previa diagnosed in the first trimester may resolve by the third trimester, persistent previa or newly diagnosed placenta previa in the third trimester of pregnancy increases the risk of placenta accreta spectrum in the current or future pregnancy. Other risk factors of the placenta accreta spectrum (previously known as morbidly adherent placenta) include a previous history of the adherent placenta, multiple gestations, placenta previa diagnosed during pregnancy, multiparity, advanced maternal age, and Asherman syndrome. This increase is due to a corresponding increase in cesarean deliveries. The incidence of the placenta accreta spectrum (accreta, increta, percreta) has increased from 1 in 4,017 in the 1980s to about 1 in 533 from 1982 to 2002, and about 1 in 272 for women who had a birth-related hospital discharge diagnosis in 2016. The most common reason why the placenta is retained after childbirth is that placental villi adhere to the uterine myometrium without invading the decidua (placenta accreta), or the villi do invade either the myometrium (increta) or the uterine serosa and adhere to various nearby organs like the bladder (percreta). Future research should consider challenging the current definition of retained placenta, defined as a placenta undelivered after 30 minutes, in favor of a shorter time period, 15 minutes undelivered, in order to mobilize the obstetric team, anesthesiologist, and blood bank to prevent catastrophic postpartum hemorrhage.Ī retained placenta is clinically diagnosed during the third stage of labor when the placenta fails to deliver within 15-30 minutes after childbirth. More data are needed to define the period of time correlating with the greatest chance of encountering a retained placenta in order to improve obstetric care and reduce maternal morbidity and mortality.

In conclusion, this case highlights that retained placenta is a serious obstetric complication that can cause life-threatening postpartum hemorrhage. The patient recovered from surgery and was discharged on postpartum day 3 with her neonate in stable condition. Vaginal bleeding was significantly reduced minor bleeding was noted from a first-degree vaginal laceration, which was repaired by suture. Sharp curettage was also used with ultrasound to confirm that the uterus was empty, followed by one more suction curettage to remove any products of conception that were scraped off with sharp curettage. The retained placenta was complicated by postpartum hemorrhage and was treated within 15 minutes of fetal delivery with several uterotonics (misoprostol, oxytocin, carboprost, and tranexamic acid) and several passes of ultrasound-guided suction curettage. We report the case of a 32-year-old female, gravida 4 para 3, who was diagnosed with a retained placenta after delivering at term (39 weeks gestation). There are several complications of a retained placenta, including postpartum hemorrhage, which can lead to maternal death if not treated promptly. Retained placenta can be caused by placenta accreta, increta, or percreta. According to the American Pregnancy Association, a retained placenta is diagnosed if the placenta is not delivered within 30 minutes following delivery of the fetus. The third stage of labor (delivery of the placenta), per current definition, takes place within 30 minutes of fetal delivery in a nulliparous or multiparous woman.