Retained Placenta and Postpartum Hemorrhage: A Case Report and Review of Literature

Abstract

The third stage of labor (delivery of the placenta), per current definition, takes place within 30 minutes of fetal delivery in a nulliparous or multiparous woman. According to the American Pregnancy Association, a retained placenta is diagnosed if the placenta is not delivered within 30 minutes following delivery of the fetus. Retained placenta can be caused by placenta accreta, increta, or percreta. There are several complications of a retained placenta, including postpartum hemorrhage, which can lead to maternal death if not treated promptly. We report the case of a 32-year-old female, gravida 4 para 3, who was diagnosed with a retained placenta after delivering at term (39 weeks gestation). The retained placenta was complicated by postpartum hemorrhage and was treated within 15 minutes of fetal delivery with several uterotonics (misoprostol, oxytocin, carboprost, and tranexamic acid) and several passes of ultrasound-guided suction curettage. Sharp curettage was also used with ultrasound to confirm that the uterus was empty, followed by one more suction curettage to remove any products of conception that were scraped off with sharp curettage. Vaginal bleeding was significantly reduced; minor bleeding was noted from a first-degree vaginal laceration, which was repaired by suture. The patient recovered from surgery and was discharged on postpartum day 3 with her neonate in stable condition. In conclusion, this case highlights that retained placenta is a serious obstetric complication that can cause life-threatening postpartum hemorrhage. More data are needed to define the period of time correlating with the greatest chance of encountering a retained placenta in order to improve obstetric care and reduce maternal morbidity and mortality. Future research should consider challenging the current definition of retained placenta, defined as a placenta undelivered after 30 minutes, in favor of a shorter time period, 15 minutes undelivered, in order to mobilize the obstetric team, anesthesiologist, and blood bank to prevent catastrophic postpartum hemorrhage.