title: Retained placenta: will medical treatment ever be possible?
abstract: The standard treatment for retained placenta is manual removal whatever its subtype (adherens, trapped or partial accreta). Although medical treatment should reduce the risk of anesthetic and surgical complications, they have not been found to be effective. This may be due to the contrasting uterotonic needs of the different underlying pathologies. In placenta adherens, oxytocics have been used to contract the retro-placental myometrium. However, if injected locally through the umbilical vein, they bypass the myometrium and perfuse directly into the venous system. Intravenous injection is an alternative but exacerbates a trapped placenta. Conversely, for trapped placentas, a relaxant could help by resolving cervical constriction, but would worsen the situation for placenta adherens. This confusion over medical treatment will continue unless we can find a way to diagnose the underlying pathology. This will allow us to stop treating the retained placenta as a single entity and to deliver targeted treatments.
authors.affiliation: Department of Women's and Children's Health, University of Liverpool, Liverpool, UK.
authors.forename: Achier D
authors.identifier: http://orcid.org/0000-0003-4811-6101
authors.initials: AD
authors.lastname: Akol
authors.affiliation: Department of Women's and Children's Health, University of Liverpool, Liverpool, UK.
authors.forename: Andrew D
authors.identifier: http://orcid.org/0000-0002-1909-337X
authors.initials: AD
authors.lastname: Weeks
mesh_terms: D000066491:Clinical Decision-Making; D019468:Disease Management; D005260:Female; D006801:Humans; D026201:Musculoskeletal Manipulations / Q000009:adverse effects / Q000379:methods; D009215:Myometrium / Q000187:drug effects / Q000503:physiopathology; D010120:Oxytocics / Q000008:administration & dosage / Q000009:adverse effects; D018457:Placenta, Retained / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D011247:Pregnancy; D020379:Risk Adjustment; D015149:Tocolytic Agents / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D010120:Oxytocics; D015149:Tocolytic Agents
keywords: Retained placenta; delivery; medical treatment; postpartum hemorrhage; way through medical treatment