Abnormal placental separation (Tissue)

Retained placenta

• Definition
  • Retention of the placental tissue inside the uterine cavity following the first 30 min postpartum.
• Risk factors
  • Prior history of retained placenta (most common)
  • Placenta previa
  • Placenta accreta spectrum
• Clinical features
  • Main feature: severe bleeding before placental delivery
  • Physical examination
    • Inability to completely separate the placenta during the third stage of labor
    • Speculum inspection: visualization of placental fragments or fetal membranes within the uterus

Abnormal placentation

Treatment

Prevention

• Active management of the third stage of labor: delivery of the placenta which involves the following components
  • Uterotonic agents (IV/IM oxytocin)
  • Controlled umbilical cord traction (Brandt-Andrews maneuver)
  • External compression of the uterus and bimanual uterine massage