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'Retained products' is where all or part of the placenta or membranes are left
behind in the uterus during the third stage of labour. Most commonly this is a
succinate lobe of the placenta, which underlines the importance of a thorough
examination of the placenta after childbirth - a vessel in the membranes apparently
leading to nothing is a sinister sign.
Retained placenta can be broadly
- failed separation due to failure of uterine contraction
or morbid adherence e.g. to a fibroid or scar
- separated but retained
due to e.g. a snapped cord contracted uterus, closed cervix
placenta is a common cause of postpartum haemorrhage, both primary and secondary.
of women with a retained placenta (1):
- intravenous access should always
be secured in women with a retained placenta
- intravenous infusion of oxytocin
should not be used to assist the delivery of the placenta
- for women with
a retained placenta oxytocin injection into the umbilical vein with 20 IU of oxytocin
in 20 ml of saline is recommended, followed by proximal clamping of the cord
the placenta is still retained 30 minutes after oxytocin injection, or sooner
if there is concern about the woman's condition, women should be offered an assessment
of the need to remove the placenta. Women should be informed that this assessment
can be painful and they should be advised to have analgesia or even anaesthesia
for this assessment
- if a woman reports inadequate pain relief during the
assessment, the healthcare professional must immediately stop the examination
and address this need
- if manual removal of the placenta is required, this
must be carried out under effective regional anaesthesia (or general anaesthesia
(September 2007).Intrapartum care.
Last reviewed 01/2018