Retained products of conception

Retained products of conception
Other names: Retained placenta
MRI showing retained products of conception in the first trimester[1]
Specialty	Obstetrics
Symptoms	Bleeding, infection[2]
Causes	Uterine atony, placenta accreta, early closure of the cervix[2]
Risk factors	Multiple prior deliveries, previous surgery of the uterus, preterm delivery[2]
Diagnostic method	Based on symptoms, examination of the placenta[3]
Differential diagnosis	Gestational trophoblastic disease[4]
Treatment	Oxytocin, dilation and curettage, manual removal[3][2][4]
Frequency	2% of term pregnancies[2]

Retained products of conception (RPOC) is when part or all of the placenta or membranes remain in the uterus in association with significant bleeding or for more than about 30 to 60 minutes following delivery of the baby.^[2][3] The condition may also occur after miscarriage or abortion.^[4] Symptoms may include postpartum bleeding, either at the time of delivery or later, pelvic pain, or infection.^[3][2][4]

Causes can include uterine atony, placenta accreta, or early closure of the cervix.^[2] Risk factors include multiple prior deliveries, previous surgery of the uterus, and preterm delivery.^[2] The underlying mechanism may involved failed separation of the placenta from the uterus or a separated but retained placenta.^[3] Diagnosis can be supported by symptoms or examination of the placenta for missing parts.^[3] Other measures may include ultrasound.^[4]

Treatment is generally by manual removal of the products under anesthesia or by dilation and curettage.^[3][2][4] Injecting the cord with oxytocin may be of benefit but requires further study as of 2020.^[3][5] Blood loss may require blood transfusions, uterine balloon tamponade, or hysterectomy.^[2] In rural areas of the developing world, it is associated with a 10% risk of death.^[6] It affects about 2% of term pregnancies; though may affect up to 40% of preterm pregnancies.^[2][4]

Signs and symptoms[edit | edit source]

Symptoms of retained placenta include bleeding and infection. After the placenta is delivered, the uterus should contract down to close off all the blood vessels inside the uterus. If the placenta only partially separates, the uterus cannot contract properly, so the blood vessels inside will continue to bleed.^[7]

Management[edit | edit source]

Manual removal of the placenta^[8]

Treatment, such as intraumbilical oxytocin, are often used in management of placental retention.^[9] It is useful to ensure the bladder is empty.^[10] However, ergometrine should not be given as it causes tonic uterine contractions which may delay placental expulsion.^[10]

Controlled cord traction has been recommended as a second alternative after more than 30 minutes have passed after stimulation of uterine contractions, provided the uterus is contracted.^[10] Manual extraction may be required if cord traction also fails,^[10] or if heavy ongoing bleeding occurs. There is currently uncertainty about the effectiveness of anaesthesia or analgesia for manual extraction, in terms of pain and the risk of postpartum haemorrhage.^[11] Very rarely a curettage is necessary to ensure that no remnants of the placenta remain (in rare conditions with very adherent placenta such as a placenta accreta).

It is common to wait for the placenta's birth up to 2 hours in some instances.

Other animals[edit | edit source]

Retention of fetal membranes (afterbirth) is observed more frequently in cattle than in other animals. In a normal condition, a cow’s placenta is expelled within a 12-hour period after calving.^[12]

See also[edit | edit source]

• Incomplete miscarriage

References[edit | edit source]

External links[edit | edit source]