Pregnancy/Maternity

Placental retention: when the placenta does not come out

Usually, a few minutes after the expulsion of the baby, the placenta comes out spontaneously. Sometimes, the placenta or a piece of it stays inside the uterus. This is called placental retention. How can you recognize this and fix it?

Today is the big day! You're giving birth, finally! After hours of hard work, your baby comes out, hooray! But imagine your surprise when the doctor asks you to push again, this time to push out the placenta.

Some women have the chance to expel their placenta naturally within minutes of delivery, others have to push to get it out. And some others may push, but the placenta, or a piece, will remain inside the uterus after the birth of the baby. This is called placental retention.

This inconvenience affects not only women who give birth at term but also those who have a miscarriage are likely to experience placental retention.
What are the causes of placental retention?

"We do not have a clear answer to that, scientifically," says Dr. Lucie Morin, Head of the Department of Obstetrics and Gynecology at CHU Sainte-Justine. The latter explains that sometimes the placenta invades the uterus, much like a tumor. "This is called placenta accreta". This pathology is the most serious cause of placental retention, but not the most common.
 
Some other conditions may make women at higher risk for placental retention: if the patient has had scarring in the uterus, if she had a prolonged limb rupture during pregnancy, or if there is a malformation of the placenta (presence of accessory lobes, for example).
Beyond all this, any woman who gives birth can experience the retention of the placenta. But, good news: just because it happens once doesn't mean it will happen next time!
When the placenta does not want to come out

As a general rule, at the hospital, intravenous Syntocinon (a synthetic oxytocin) is immediately given to all patients after the expulsion of the baby. "It's done to make it easier to expel the placenta and prevent postpartum hemorrhage," says Dr. Morin. If you do not have an IV, this synthetic hormone will be given to you by injection.

In a birth house, generally, we will let time do its job. On the other hand, if the placenta does not come out naturally within 30 to 45 minutes after the baby's exit, you will also be entitled to these injections of Syntocinon.

If the placenta still does not want to come out, the doctor will try to pick it up with their hand or a tool. "If the patient does not have anesthesia, we will take her to the operating room to give her anesthesia and we will get the placenta out with our hand or with other tools" explains Dr. Morin. It is unpleasant, however, it is a fairly simple procedure that takes a short amount of time.


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