Retained placenta

What is retained placenta?

Retained placenta is when some of the placenta stays in your uterus after your baby is born.

Retained placenta happens in around 2 out of 100 births.

If untreated, a retained placenta can lead to severe infection or life-threatening blood loss.

How is the placenta delivered after birth?

After your baby is born, you will need to birth the placenta. This is called the third stage of labour. This can take anywhere from 5 to 30 minutes after you give birth to your baby.

There are two approaches to managing the third stage, known as:

• active management (with medical assistance)
• natural (also known as physiological or expectant)

You may choose to ‘actively manage’ this stage of labour which means that your midwife or doctor will:

1. Give you an injection of synthetic oxytocin to help your uterus contract.
2. Clamp and cut your baby’s umbilical cord.
3. Gently pull on the umbilical cord; this helps speed up the birthing of the placenta.

Active management reduces the risk of heavy bleeding from the vagina (postpartum haemorrhage) following birth.

Choosing natural management means that you want to wait for the placenta to pass through the birth canal naturally, with the help of gravity and some contractions. This may take up to one hour.

You midwife or doctor can help you make an informed decision about which option is best for you. You may choose to write your preferences in a birth plan.

What are the symptoms of retained placenta?

Symptoms of a retained placenta include:

• fever
• heavy bleeding
• bad-smelling discharge from your vagina
• many large clots coming out of the vagina

Contact your doctor or medical team as soon as possible if you have any heavy bleeding from your vagina or pain in the days or weeks following birth. If the bleeding or pain become more severe, call triple zero (000).

CHECK YOUR SYMPTOMS — Use the Symptom Checker and find out if you need to seek medical help.

What causes retained placenta?

The placenta may be retained after your baby is born if:

• your contractions aren’t strong enough to deliver it
• you have placenta accreta (when the placenta implants too deeply into the wall of the uterus)
• the cervix closes before the third stage of labour is complete and traps the placenta inside your uterus
• your bladder is full, blocking the delivery of the placenta

When should I see my doctor?

It’s important to contact your doctor or medical team as soon as possible if you pass many large clots or your post-birth bleeding becomes:

• heavier
• bright red
• foul-smelling

It is normal to experience bleeding after the birth of your baby. The amount of bleeding varies from person to person. Most people have moderate to heavy bleeding for the first few days which gradually decreases and becomes more brownish. Usually, the bleeding stops between 4 to 6 weeks after you give birth.

It is also common to bleed more heavily right after breastfeeding, but this should settle quickly.

If the bleeding or pain become severe, call triple zero (000) and ask for an ambulance.

How is retained placenta diagnosed?

Your doctor or midwife will diagnose retained placenta if the placenta hasn’t completely emerged from your uterus within 30 minutes (if you are actively managed) or 1 hour (if you choose natural / physiological management).

After you give birth to your baby and the placenta is delivered, the midwife or doctor will check your placenta to make sure it is complete.

If you have symptoms of retained placenta in the days or weeks after birth, your doctor may refer you for an ultrasound scan to check.

What is the treatment for retained placenta?

If you have just given birth, retained placenta might be treated by:

• emptying your bladder
• your doctor or midwife gently pulling on the umbilical cord
• changing your position
• encouraging breastfeeding or nipple stimulation

If that doesn’t work, or your doctor diagnoses retained placenta days or weeks after your baby’s birth, you may need surgery to remove the placenta. This surgery is usually done with an epidural or general anaesthetic, so you won’t feel any pain.

While you’re waiting for surgery, your midwife will monitor your bleeding and general health.

If you needed help to deliver your placenta, especially if you had a fever or needed surgery, it’s likely your doctor will also prescribe antibiotics to prevent infection.

What are the complications of a retained placenta?

Complications of retained placenta include:

• uterine infection (endometritis)
• postpartum haemorrhage

Learn more about postpartum haemorrhage.

What can I expect recovering from retained placenta?

If you experienced complications you may need to recover for longer than expected in hospital. Recovery can be more difficult if your birth didn’t go as planned.

If you experience unexpected problems during pregnancy and birth, you may feel disappointed, sad or distressed. It’s important to speak with your medical team about how you are feeling so they can help you and your family through your recovery.

Learn more about the emotional impact of birth trauma.

If you need to talk to someone about your mental health call Beyond Blue on 1300 22 4636.

Resources and support

You can find further help and information from these organisations:

• The Australian Birth Trauma Association offers advice, resources, and a peer support service.
• The Centre of Perinatal Excellence (COPE) has information and a list of support services.

You can also call:

• Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call. Available from 7 am to midnight (AET), 7 days a week (including public holidays).
• Perinatal Anxiety & Depression Australia (PANDA) on 1300 726 306 to speak with a counsellor.