During the third stage of labor, the placenta and amniotic membranes will be delivered. This part of labor is known as the afterbirth and can take anywhere from 5 minutes to an hour. However, in approximately 2% of all births, some or all of the placenta/membranes remain intact. This is called a retained placenta. A retained placenta is more common in preterm deliveries and in women that have previously experienced a retained placenta in earlier deliveries.
One reason that the placenta may remain intact is if the umbilical cord is pulled away from the placenta as it is being delivered. In some cases, the placenta has not fully detached from the uterine wall as the healthcare provider gently pulls on the cord. This may cause the umbilical cord to pull away from the placenta and the placenta will be left inside of the uterus. Part of the placenta may also be left inside the uterus without the doctor being aware. A succenturiate lobe occurs when a piece of the placenta is connected to a blood vessel and is left behind after the afterbirth has been delivered. Placenta acretta is a rare form of a retained placenta and occurs in approximately 1 in 2,500 births. Placenta acreta occurs when part of the placenta attaches itself to a fibroid or uterine scar from a cesarean section.
If the entire placenta has not been removed from the uterus after delivery, the uterus will not be able to contract and the blood vessels will bleed. Heavy bleeding is likely approximately 45 minutes after the birth of the baby if the placenta has not been fully removed. Heavy bleeding that occurs during the first 24 hours of delivery is known as Primary Postpartum Hemorrhage (PPH). Heavy bleeding that continues after the first 24 hours of delivery is known as Secondary Postpartum Hemorrhage.
Once the afterbirth has been expelled, it is immediately examined and the doctor should notice if there is part of the placenta missing. If the doctor immediately realizes that the entire placenta has been left inside of the uterus because it has detached from the umbilical cord and the cervix has not closed, it may still be delivered with the next contraction. Because breastfeeding causes the uterus to contract, nursing your baby may also help in the delivery of the placenta. The woman will be asked to push with the next contraction as the placenta is delivered. However, this is not always an option. In the event that part of the placenta has been retained, it is usually removed and the woman is placed under general anesthesia. In more severe cases, a hysterectomy will be likely because extreme bleeding will occur.
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