What Happens If Parts of the Placenta Remain After Giving Birth?

After giving birth to your baby, you still need to expel the placenta or the structure that nourished your baby throughout their stay in your womb. Unfortunately, sometimes, the placenta (afterbirth) remains attached in the womb. This condition is called retained placenta and it can lead to serious complications and death. In some cases, almost all of the afterbirth is delivered, but some parts remain. These retained placental fragments may cause problems days, weeks, or months after getting out of the hospital. Here’s what you need to know about these instances.

Retained Placenta, an Overview

Placenta is an organ that connects the fetus to the uterus during pregnancy and provides food, oxygen, and nutrients to the developing baby. Usually, within half an hour after the baby is born, the placenta detaches and is expelled.

A retained placenta is a complication of childbirth in which the placenta stays in the uterus for longer than 30 minutes after the delivery of the baby.

But, what of retained placental fragments?

Retained placental fragments, on the other hand, occur when the majority of the placenta is delivered, but some of the tissues remain. This may not be noticeable right away and the symptoms may only happen days, weeks, or even months after giving birth. In some cases, too, the fragments do not just come from the placenta, but also from the fetus. This is why experts call it Retained Products of Conception (RPOCs) instead.

Causes and Risk Factors

Retained placenta usually happens because the uterus won’t contract effectively (uterine atony), the placenta is too attached (which can happen in conditions, like Placenta Accreta Spectrum), or the cervix closes before it can be expelled.

Retained placental fragments (or RPOCs, in general) commonly happen when the pregnancy ends early. Below are the factors that can increase the risk of RPOCs:

• History of retained placenta
• Placenta accreta spectrum
• Assisted delivery, like forceps delivery
• Advanced maternal age
• Prolonged use of oxytocin
• Past C-section or uterine surgery
• Prolonged labor

Signs and Symptoms

The symptoms of retained placenta include heavy bleeding and uterine pain. But, the most obvious sign is when the placenta doesn’t detach within 30 minutes after the baby is born.

As for retained placental fragments or RPOCs, they are the most common cause of postpartum bleeding. Days, weeks, or months after giving birth, RPOCs may lead to:

• Bleeding (might be heavy in some cases)
• Fever
• Enlarged uterus
• Pelvic pain

If you’ll notice, retained placental fragments may not progress as quickly as retained placenta, but they are still dangerous.

It’s Crucial To Treat RPOCs Right Away

If you have symptoms of retained placental fragments, you MUST seek medical attention immediately. The sooner it is treated, the better. Left untreated, RPOCs can lead to infection, blood loss, and even death.

To treat RPOCs, the doctor may:

• Give you misoprostol or medicines that will induce labor so that the uterus will contract and expel the fragments.
• Perform dilation and curettage, a minor surgery where they will remove the contents of the uterus with the use of a curette or suction.

Misoprostol is not associated with any significant risk, but D&C have a risk for bleeding, infection, scarring, or perforation (a hole is formed in the uterus). Most women who receive treatment for RPOCs can get pregnant again, but some scarring in the uterus may cause fertility issues.

Learn more about Labor and Delivery here.