The retained placenta.
The incidence and importance of retained placenta (RP) varies greatly around the world. In less developed countries, it affects about 0.1% of deliveries but has up to 10% case fatality rate. In more developed countries, it is more common (about 3% of vaginal deliveries) but very rarely associated with mortality. There are three main types of retained placenta following the vagina delivery: placenta adherens (when there is failed contraction of the myometrium behind the placenta), trapped placenta (a detached placenta trapped behind a closed cervix) and partial accreta (when there is a small area of accreta preventing detachment). All can be treated by manual removal of placenta, which should be carried out at 30-60 minutes postpartum. Medical management is also an option for placenta adherens and trapped placenta. The need for manual removal can be reduced by 20% by the use of intraumbilical oxytocin (30 i.u. in 30 mL saline). A trapped placenta may respond to glyceryl trinitrate (500 mcg sublingually) or gentle, persistent, controlled cord traction.
Weeks
Andrew D
AD
School of Reproductive and Developmental Medicine, Liverpool Women's Hospital, Crown Street, Liverpool L8 7SS, UK. aweeks@liverpool.ac.uk
D005260:Female; D006801:Humans; D007749:Labor Stage, Third; D005996:Nitroglycerin / Q000008:administration & dosage*; D010120:Oxytocics / Q000008:administration & dosage*; D010121:Oxytocin / Q000008:administration & dosage*; D018457:Placenta, Retained / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D011247:Pregnancy; D014470:Umbilical Cord
D010120:Oxytocics; D010121:Oxytocin; D005996:Nitroglycerin