What is a Retained Placenta?

If your placenta is not delivered within 30 to 60 minutes after your baby's birth, this is known as a retained placenta. A retained placenta requires medical attention, but it is very rare. Here's what moms need to know about a retained placenta.

What is a retained placenta?

A retained placenta is a placenta that stays in the uterus (womb), and that is not delivered shortly after your baby is born. This happens very rarely – in only 2-3% of pregnancies.

The placenta is the organ that's responsible for nourishing your baby during pregnancy. It develops in the womb, is connected to the uterine wall and umbilical cord, and passes nutrients, water, oxygen, and carbon dioxide to your baby while they're in the womb.

When your baby is delivered, the placenta is no longer needed. So, the placenta detaches from the wall of the uterus and gets pushed out during contractions.

During the third and final stage of your baby's delivery, you'll normally deliver the placenta. This usually happens 5-30 minutes after birth.

But in rare cases, part or all of the placenta is not delivered within 30-60 minutes after birth. This is called a retained placenta.

Why does a retained placenta happen?

There are several possible causes of a retained placenta:

  • Part of the placenta grew into or through the uterine wall (the uterus muscles)
  • Part or all of the placenta gets "caught" in the corner of the uterus during contractions
  • Your contractions aren't strong enough to push out the placenta
  • Your cervix closes before part or all of the placenta is delivered, and that traps the remaining placenta in your uterus

Types of retained placenta

Doctors classify a retained placenta into one of three types, depending on what caused the retained placenta:

  • Trapped placenta: The placenta detached from the uterine wall during contractions, but part or all of it didn't make it out of the body (usually due to a closed cervix).
  • Placenta adherens: Contractions weren't strong enough to detach the placenta from the uterine wall.
  • Placenta accreta: The placenta grew deep into the layers of the uterus, so it won't detach. This is the rarest type of retained placenta, and the most serious. It can cause extensive blood loss. Blood transfusions or removal of the uterus may be needed in severe cases.

Risk factors for retained placenta

Although it's rare, any mother can have a retained placenta.

But some mothers are at increased risk of a retained placenta. This includes mothers who:

  • Are delivering their baby prematurely
  • Had very long first and second stages of labor during this pregnancy
  • Had a retained placenta during another delivery
  • Have given birth many times
  • Have fibroids
  • Have abnormalities of the uterus
  • Conceived via IVF
  • Previously had a C-section
  • Previously had another surgery of the uterus
  • Are delivering a stillborn baby
  • Have taken oxytocin medication for too long

Symptoms of a retained placenta

The easiest and most common way to identify a retained placenta is if part or all of the placenta wasn't delivered within 30-60 minutes of delivering your baby.

If that happens, you may notice symptoms like these days or weeks after delivery:

  • Heavy and sustained bleeding
  • Blood clots or large tissue pieces coming from the vagina
  • Fever
  • Foul-smelling vaginal discharge
  • Painful cramping or other lasting pain

Can a retained placenta cause complications?

A retained placenta poses no danger to your baby. After all, your baby is already delivered before the placenta is retained.

Unfortunately, though, a retained placenta can sometimes cause risky complications for new mothers.

The most serious possible complication of a retained placenta is heavy and sustained blood loss (also called postpartum hemorrhage). If this occurs, the mother may need a blood transfusion or other immediate medical assistance.

But labor and delivery doctors and nurses know how to identify the causes of this bleeding, and take steps to stop it as soon as possible.

If only small parts of the placenta are retained, a mother probably won't have abnormal bleeding right away. But a mother could end up with heavy bleeding a week or two after delivery, or painful cramps around two weeks after delivery. A retained placenta might also lead to lengthened postpartum bleeding.

A retained placenta could also lead to an infection, which could prompt heavy, bright red bleeding that requires emergency attention.

If you experience heavy and sudden bleeding one to three weeks after birth, seek emergency care immediately.

Retained placenta treatment

There are several different ways that a retained placenta can be removed.

  • In some cases, urination is enough to get your body to pass the remaining placenta (if your full bladder trapped the placenta for a bit).
  • Breastfeeding right away can also help your body deliver the placenta, because it naturally encourages contractions.
  • A doctor, nurse, or midwife can sometimes get the placenta out manually, by gently tugging on the umbilical cord. Or, they might use an instrument to remove it shortly after birth.
  • Or, they may give you medications to help the uterus contract.
  • But if none of these work, or it's at least a week after birth, you will likely need surgery to remove the placenta. Surgery is only used as the last option to remove the placenta, because there's a risk of further complications.

Can a retained placenta be prevented?

There are several techniques that your doctor can use to help you deliver the placenta in a timely manner (and help prevent retained placenta):

  • Massaging the uterus
  • Changing positions to help aid contractions
  • Encouraging breastfeeding to promote contractions
  • Medications

Keep in mind that a retained placenta is rare. If it does occur, your labor and delivery team is prepared, and will take the necessary steps to prevent further complications.

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