Retained placenta

After your baby is born, your body needs to deliver the placenta, which kept your baby nourished throughout pregnancy. Delivering the placenta is called the third stage of labour.

A retained placenta is when part or all of the placenta is left in the womb after you have your baby. It needs to be treated early to avoid complications. 

How is the placenta usually delivered? 

After your baby is born, your body needs to deliver the placenta, which kept your baby nourished throughout pregnancy. Delivering the placenta is called the third stage of labour. 

If you have a caesarean section, the placenta will be delivered by your medical team after your baby is born.  

If you have a vaginal birth, there are 2 ways to deliver the placenta. 

• Active management is when a drug called oxytocin is injected into your thigh to make your womb contract and help the placenta come away more quickly. 
• Physiological management is when you deliver the placenta after the birth yourself without being given medication. 

Your midwife or doctor can talk to you about the pros and cons of each option. 

Find out more about delivering the placenta.  

What is a retained placenta? 

A retained placenta is when some or all of the placenta stays in your womb (uterus). It needs to be removed to prevent complications such as heavy bleeding. 

You will be diagnosed with a retained placenta if it isn’t delivered in a certain amount of time. The time will depend on which method of management you had. Your doctor or midwife will diagnose retained placenta and discuss treatment options with you if all or part of the placenta remains in the womb after: 

• 30 minutes of your baby’s birth if you have active management 
•  1 hour of your baby’s birth if you have physiological management

Up to 3 women in every 100 are diagnosed with a retained placenta.  

Why is a retained placenta a problem? 

If a retained placenta is not diagnosed and treated, it can cause heavy bleeding, which is known as primary postpartum haemorrhage (PPH). This can be life-threatening if it is not treated. Although this sounds scary, your midwife or doctor will be ready to treat PPH in any setting where you are giving birth.  

How is retained placenta treated? 

Your doctor or midwife will advise different ways to get the womb to contract and the placenta to come away, such as: 

• helping you empty your bladder 
• asking you to breastfeed your baby to release more of your body’s own oxytocin, which makes your womb contract 
• massaging the top of your womb through your tummy 
• asking you to change your position (for example, by moving to a sitting or squatting position) 
• switching to active management with an injection of oxytocin.

The womb can become tired after a long labour and contractions can become less effective after the baby is born. Oxytocin helps to increase your contractions and speed up delivery of the placenta. 

If this does not work, your midwife or doctor will talk to you about removing the placenta by hand (manually). If they cannot remove it by hand, you will be taken to an operating theatre where  an obstetrician (a doctor who specialises in delivering babies) will remove the placenta.  

Your birth partner and newborn may be able to come with you to theatre if you want them to. Your baby can stay with your birth partner if you do not want them to come with you, or there is a medical reason why they cannot come.

Your medical team will give you medication that will reduce the risk of heavy bleeding and keep your womb contracted. This is given through an intravenous cannula, a thin tube that is be inserted into a vein, typically in your hard or the crease of your arm.  

You will then be offered a vaginal exam to find out exactly where the placenta is. This can be painful, so you will be offered some pain relief. Tell the midwife or doctor if you are still in pain during the examination as they can stop and give you more medication.

You will be offered an epidural or spinal anaesthetic, which means you will be awake but you will not feel any pain.  

The operation happens manually (using the doctor’s hands). If the placenta is sitting in the cervix your obstetrician can remove it pull it out through your vagina. If it is in your womb, they will detach the placenta from the wall with their fingers and gently pull it out.

There is a risk of infection, so you will be given antibiotics through the drip in your arm and prescribed more oral antibiotics.

What if some of the placenta is left in my womb?  

Even if you have your placenta removed in this way, there is a risk that some small pieces of tissue or membrane may be left behind. These are sometimes called ‘retained products of conception’.

It is normal to feel some discomfort, cramping and bleeding after delivery. But contact your doctor or midwife if you have any of these symptoms in the days and weeks after giving birth. 

• High temperature 
• Feeling sick or vomiting 
• Difficulty breathing 
• Heavy bleeding or blood clots from your vagina – it may be difficult to know what ‘heavy’ is so wear a sanitary towel (never a tampon) to show your midwife or doctor if you’re worried 
• Severe pelvic pain. 

Your doctor may suggest you have a transvaginal ultrasound scan to check for any remaining tissue. If there is any left, your doctor may refer you for surgery to remove it.

Always contact your doctor, midwife or health visitor if you are worried about any symptoms after having a baby.  

What causes a retained placenta? 

There are 3 main causes of a retained placenta: 

• the womb does not contract enough to force the placenta to come away from the wall of the womb 
• the placenta attaches too deeply into the wall of the womb (placenta accreta)  
• the placenta becomes trapped behind the cervix as it starts to close after your baby’s birth.

Some things may increase your risk of having a retained placenta, such as if you: 

• had a retained placenta before 
• have given birth prematurely 
• had previous surgery on your womb, such as a dilation and curettage (D&C) 
• had a previous abortion 
• had 1 or more miscarriages 
• have given birth more than 5 previous births  
• had abnormalities of the womb.

Another study found that retained placenta was more likely if there was a family history of it on both the maternal (mother or birthing parent) and paternal (biological father) sides.

Will I have a retained placenta if I give birth again? 

If you had a retained placenta in a previous pregnancy, you do have a higher risk of it happening again. There is nothing you can do to lower the risk, but this does not mean it will definitely happen in your next pregnancy.  

Do talk to your midwife if you have any concerns at all about your next pregnancy. They are there to help support and reassure you, and they will answer any questions you have.