Retained Placenta: Causes, Symptoms, and Treatment Options

We all remember that classic scene from old Arabic movies when the midwife would ask everyone not to tell the mother the baby’s gender until after the placenta—known colloquially as “the afterbirth”—had been delivered. This traditional belief stems from the idea that the mother’s emotional state immediately after birth could affect how quickly the placenta is expelled, a crucial step to complete the birthing process.

However, some women experience a complication after the baby is born called retained placenta, when the placenta does not come out naturally. To understand this condition better, Sayidaty & Your Baby spoke with Dr. Israa Abdullah, Consultant in Obstetrics and Gynecology, who explained what every expectant mother should know about retained placenta—its symptoms, causes, and treatment options—to prevent serious complications for both mother and baby.

What Is the Placenta?

The placenta is often called a temporary organ because it develops in the uterus only during pregnancy to serve a specific purpose. It attaches to the uterine wall via the umbilical cord, supplying the growing baby with oxygen and nutrients while removing waste products and carbon dioxide from the baby’s blood.

It also transfers antibodies from the mother’s bloodstream to strengthen the baby’s immune system, providing short-term protection after birth. The placenta forms during the early weeks of pregnancy and, under normal circumstances, leaves the mother’s body within about an hour after delivery.

The Stages of Natural Childbirth

A normal vaginal delivery takes place after about 40 to 42 weeks of pregnancy and consists of three main stages:

1. The first stage – Labor contractions:
   This stage begins with uterine contractions that gradually open the cervix. It can vary greatly from one woman to another and may last up to 48 hours, especially in first-time mothers. The early (or “latent”) phase involves mild, irregular contractions and the softening of the cervix. During this time, the mucus plug that seals the cervix may dislodge, signaling that labor is near.

   The active phase begins when the cervix starts to dilate more rapidly—up to about 10 centimeters. Contractions become stronger, longer, and closer together. The mother may experience nausea, back pain, or leg cramps due to hormonal changes and increased uterine activity.

2. The second stage – Delivery of the baby:
   This is when the baby moves through the birth canal and the head begins to crown. The rest of the body follows quickly due to the combined effects of gravity and the mother’s pushing efforts. If the baby’s size is large or the mother pushes too forcefully without synchronized contractions, a tear in the perineal area may occur. In such cases, the doctor performs a few cosmetic stitches that dissolve naturally within days, provided proper hygiene and topical antiseptics are used.

3. The third stage – Delivery of the placenta:
   This final stage is just as important as delivering the baby, as failure to expel the placenta promptly can endanger the mother’s life. Normally, the placenta is delivered within 30 minutes of childbirth, assisted by gentle pressure on the mother’s abdomen from the physician.

What Causes Retained Placenta?

Retained placenta refers to a rare condition in which the placenta fails to detach from the uterine wall after childbirth. While the exact cause is often unknown, medical studies have linked it to several factors, including abnormal deep attachment of the placenta to the uterine lining.

In some cases, this condition develops into placenta accreta, where the placenta grows too deeply into the uterine wall during pregnancy. Previous cesarean sections or uterine surgeries can create scar tissue (uterine scarring), increasing the risk of abnormal placental attachment.

Complications of a Retained Placenta

Retained placenta is one of the most serious childbirth complications. It can be life-threatening if not treated promptly. If ultrasound scans during pregnancy detect an abnormally attached placenta, doctors often recommend a planned cesarean section to safely remove both the baby and the placenta.

In severe cases where the placenta remains stuck after delivery, the doctor may need to perform a hysterectomy (surgical removal of the uterus) to save the mother’s life. Retained placenta can lead to severe postpartum hemorrhage, infection, tissue damage, and blood clots, all of which can be fatal if uncontrolled.

In many cases, however, doctors manage the condition by manually removing the placenta, using medical instruments, or administering intravenous medications that help the uterus contract and expel the placenta naturally—preventing the need for surgery.

Recognizing the Signs

A woman may experience light bleeding in the later months of pregnancy, which can sometimes indicate abnormal placental attachment. If this occurs, immediate medical evaluation is essential. The doctor will perform an ultrasound scan and take necessary precautions during delivery to reduce the risk of complications.