From the Research
A retained placenta 3 months postpartum is a rare but serious condition requiring prompt medical intervention, and the primary treatment is surgical removal through a procedure called hysteroscopy or dilation and curettage (D&C), performed under anesthesia to safely extract the retained placental tissue. The condition can cause significant morbidity and mortality if left untreated, and it is essential to prioritize the patient's quality of life and prevent potential complications such as infection, hemorrhage, or Asherman's syndrome (uterine scarring) 1.
Diagnosis and Treatment
Prior to surgery, imaging studies such as ultrasound or MRI will be conducted to confirm the diagnosis and locate the retained tissue. Antibiotics are typically prescribed to prevent or treat infection, commonly including ampicillin (2g IV every 6 hours) plus gentamicin (5mg/kg IV daily) until the patient is afebrile for 24-48 hours. If the patient is experiencing significant bleeding, measures to control hemorrhage may be necessary, including IV fluids, blood transfusions if anemia is severe, and possibly medications like oxytocin (10-40 units in 1L IV fluids) or methylergonovine (0.2mg IM every 2-4 hours) to contract the uterus 2.
Risk Factors and Complications
Risk factors for retained placenta include previous cesarean section, previous abortions, lower parity, lower gestational age at delivery, hypertensive disorders, oligohydramnios, and labor and delivery interventions such as induction of labor, neuro-axial analgesia, and vacuum delivery 3. Complications can include major hemorrhage, endometritis, or retained portions of placental tissue, which can lead to delayed hemorrhage or infection 2.
Management and Prevention
Management entails manual removal of the placenta with adequate analgesia, as medical intervention alone has not been proven effective 2. Prophylactic antibiotics can be considered with manual placenta removal, though evidence regarding effectiveness is inconsistent 4. If hemorrhage is encountered, deployment of a massive transfusion protocol, uterine evacuation with suction, and use of intrauterine tamponade, as with an intrauterine balloon, should be initiated immediately 2. Patients with risk factors for retained placenta should have a laboratory sample sent for blood type and antibody screening on admission to labor and delivery, and plans should be made for appropriate analgesia and preparations for hemorrhage if a retained placenta is encountered 2.