While being pregnant is most magical and thrilling experience of life, but there are moments that could be uncomfortable and annoying. During pregnancy, our body goes through many emotional and psychological changes. Placenta formation is one of them. The placenta is an important organ which begins to form in week 4 of pregnancy. It is a circular vascular organ in the uterus of pregnant mammals, nourishing and maintaining the fetus through the umbilical card. Normally, placenta and fetal membrane are expelled from the uterus after the birth of the baby.
Placental expulsion is associated with the third stage of labor. The third stage of labor has two type of management options:
- Physiological Third Stage
- Managed Third Stage
In physiological third stage, uterus naturally starts to contract again after the birth of the baby and this makes the placenta detach from the wall of the uterus. In managed third stage (usually in the case of high-risk pregnancy), certain medication like oxytocin is used. The medication helps the uterus to contract down and push out the placenta and membranes.
In physiological third stage, the placenta may take up to 1 hour to come out and in the managed third stage, it usually comes out within 30 minutes of the birth of the baby.
If a placenta does not come out within this span of time (according to selected stage), then it will be called a retained placenta. In humans, retained placenta is generally defined as “a placenta that has not undergone placental expulsion within 30 minutes of the baby’s birth, where the third stage of labor has been managed actively.”
According to NCBI, retained placenta is a significant cause of maternal morbidity and mortality throughout the developing world. It complicates 2% of all deliveries and has a case mortality rate of nearly 10% in rural areas.
There are certain factors that may be called “causative factors” in a case of retained placenta. According to Women and Newborn Health Service, the risk for retained placenta may increase if uterus contains a fibroid, is bicornuate, or has a septum. The placenta may also become retained, if trapped in the cervix or lower uterine segment or if the woman has the full bladder.
Causative Factors
1. Uterine Causes
Uterine atony (a condition in which uterus does not contract enough to separate the placenta from the wall of the uterus) is a major cause of retained placenta. Occasionally, other uterine abnormalities like bicornuate uterus may be associated with it.
2. Placental Causes
There may be three types of abnormalities in the placental attachment. These are called Placenta percreta, Placenta accreta, and Placenta increta. In these conditions, the placenta attaches itself too deeply into the wall of the uterus. And depending on the severity and deepness condition is called placenta accreta, placenta increta, or placenta percreta.
Sometimes, a detached placenta is trapped behind a closed cervix, and then it is called a trapped placenta. And when myometrium behind the placenta fails to contract and placenta remain attached to the uterine wall for an abnormally long time following birth, the condition is called placenta adherens.
3. Other Causes
Full bladder and the strong emotional reaction may cause retained placenta in some cases. Even though there are no fixed risk factors, but there are certain factors that can be called “high-risk factors” such as:
- Previous history of retained placenta
- Previous injury or surgery to uterus (history of any uterine surgery because of any disease or injury)
- Preterm labor (early onset of labor may be a dominating factor)
- Pregnancy associated with hypertension
- Induced labor (sometimes high-risk cases or any other factors that require induced labor may cause retained placenta)
- Multiparity (having more than 2 children)
Signs And Symptoms
The most obvious sign of retained placenta is a failure of all or a part of the placenta to come out from the body within an hour after delivery. If the placenta remains in the body, women will experience following symptoms the day after delivery. It may be:
- Heavy bleeding and post-partum hemorrhage
- Severe pain that persists
- Foul-smelling vaginal discharge
- Tummy cramps
- Lack of breast milk
- Examination of the placenta shows possible tears or missing pieces.
Diagnosis
Usually, diagnosis is made on the symptomatic basis. If your doctor suspects that it is a case of retained placenta, he may perform an USG test for confirmation. Transvaginal sonography is slightly superior in this examination, due to its higher resolution.
Management
General management is very important in every case. Sometimes, only general management work like a miracle and give instant relief to patients. In a case of retained placenta, doctors prefer some general measures such as:
- Emptying the bladder
- Changing the position that encourages an upright position
- Breastfeeding or nipple stimulation for promoting uterine contraction
In spite of these measures, if there is no improvement in the patient’s condition, it is must to move on to the second step and that is the manual removal of placenta.
1. Manual Removal Of Placenta
This is the most common practice to remove the placenta. The doctor may be able to remove retained placenta, manually. It is usually carried under anesthesia. There are two indications for this method:
- If the sudden occurrence of hemorrhage occurs, but the placenta gives no indication of delivering
- If after the birth examination of placenta shows missing placental fragments.
Whenever these two indications are present, the doctor prefers manual removal of placenta. But this method carries an increased risk of infection.
2. Dilatation And Curettage
It is the second method to treat retained placenta. Dilation refers to the opening of the cervix and curettage refers to the removal of tissues from the uterus through the scrapping under proper medication.
It is also advisable to understand the complication of any disease. Retained placenta also has some dreading complications, if left untreated for a while.
Complications
- Life-threatening like shock (hypovolemic)
- Post-partum hemorrhage
- Puerperal sepsis
- Hysterectomy
- Uterine inversion
Alternative Treatment: Homeopathic Approach
Although homeopathic remedies work on the principle of “individualization” – meaning – any remedy can be prescribed on the basis of individual symptoms and may provide an ideal cure, there are certain remedies that can work great in retained placenta.
Preventive Medicines
Arnica is the best remedy that should be used at the beginning of and hourly throughout the labor. A dose of Arnica-200 can be given to the mother after the childbirth to minimize the pain and to improve muscle control. It is also helpful for the prevention of post-partum hemorrhage.
1. Female Remedies: Sepia, Pulsatilla, and Cimicifuga are main female remedies that can be used, according to symptoms similarities.
- Sepia: Most useful for women who have had many babies and feeling exhausted during labor with violent bearing down pain as if everything come out. Mentally she is sad, irritable and indifferent to everything.
- Pulsatilla: It is the good remedy when there are malposition baby and history of constipation and hemorrhoids in pregnancy.
- Cimicifuga: When there is the irregular but painful contraction. This remedy helps to dilate the cervix. The mentally patient is sensitive to noise and irritable. Worse from the cold.
- Cantharis: It is another good remedy that has expulsive action. Strong desire to urinate but only a few drops are passed with burning and cutting pain is the most characteristic symptom.
2. Anti-Hemorrhagic Remedies: Phosphorus, Milifolium, and Secal Cor can be used to control post-partum hemorrhage, according to symptoms similarity.
Although prevention is always better than cure, unfortunately, in the case of retained placenta, there are no fixed preventive measures. If there is a history of retained placenta in the previous pregnancy, there are higher chances of recurrence in the next pregnancy also. The best thing is that if there is a history of retained placenta in the previous pregnancy or if you’ve had any other risk factors (preterm labor, stillbirth, or hypertension), inform the doctor about it, so he can try to manage your third stage of labor effectively, with proper medication to prevent the recurrence and other complications.
