


Retained placenta

What is a retained placenta?

If you have a retained placenta, it means that all or part of the placenta or membranes have stayed inside your womb (uterus) after the birth of your baby. Normally, your body expels the placenta and membranes after your baby is born, and they slide out easily through your vagina. This is called the third stage of labour.

If your pregnancy, labour and birth have gone well, you can choose how your doctor will care for you during your third stage. You'll be able to discuss this with her before the birth. You can opt for a physiological (natural) third stage or a managed third stage.

With a physiological third stage, your womb naturally starts to contract again after the birth. This makes the placenta detach from the wall of your womb, and helps you to push it out.

With a managed third stage your doctor gives you an injection in your thigh, just as your baby is being born. This is likely to be Pitocin if you’ve had complications like high blood pressure or pre-eclampsia during pregnancy.

This injection helps your womb to contract down and push out the placenta and membranes. Having a managed third stage reduces the risk of heavy bleeding immediately after your baby is born (Begley et al 2011).

What causes a retained placenta?

The three main causes of a retained placenta are:
  • When the womb stops contracting, or doesn't contract enough for the placenta to separate from the wall of the womb. This is called uterine atony.
  • When all or part of the placenta is firmly stuck to the wall of the womb. This is called an adherent placenta. In rare cases, this happens because part of the placenta has deeply embedded itself in the womb. This is called a placenta accreta, and is more likely if the placenta embeds itself over a previous caesarean section scar. If the placenta has grown all the way through the wall of the womb it is called a placenta percreta (Weeks 2008).
  • When the placenta comes away from the womb, but becomes trapped behind your semi-closed cervix. This is called a trapped placenta (Weeks 2008).

Occasionally, it helps the placenta to come out if your doctor gives the umbilical cord a gentle tug. However, the cord may break if the placenta hasn't completely separated, or if the cord is thin.

If this happens, you may be able to help deliver the placenta by pushing with a contraction.

How is a retained placenta treated after my baby’s birth?

If you chose a physiological third stage, you may find it doesn't go as you'd hoped. The placenta may take longer than an hour to come out, or you may have heavy bleeding. It that's the case, your doctor will offer to shorten the third stage. She’ll recommend an injection of syntometrine or syntocinon (NCCWCH 2014). This will make your womb contract strongly, which should help your placenta to come away.

After a managed third stage, if the placenta is retained, your doctor may offer you another injection (NCCWCH 2014). Or she may just wait a bit longer to see if it comes away on its own (Nardin et al 2011).

In both cases, your doctor will then assess whether the placenta has separated from your womb and, if it has, she will then gently pull it out.

Your doctor will keep a close eye on you, because if the managed delivery of the placenta takes longer than 30 minutes, your risk of heavy bleeding increases (Magann et al 2013). Heavy bleeding in the first 24 hours after birth is known as primary postpartum haemorrhage (PPH).

If the third stage is taking longer than normal your doctor may recommend you have a syntocinon drip in your arm in case of increased blood loss. This is nothing to worry about and is usually just a precaution.

You'll be treated for retained placenta if your placenta is not delivered:
  • within one hour of your baby's birth if you have a physiological third stage
  • within 30 minutes of your baby's birth if you have a managed third stage
  • (NCCWCH 2014)

Your doctor will also treat you for retained placenta if only part of your placenta delivers and part remains inside you.

If the placenta still hasn't been delivered after initial treatment, your doctor may need to remove it by hand (NCCWCH 2014). You won't feel discomfort during this procedure, because an anaesthetist will numb the area for you. You may have a regional anaesthetic such as a spinal or epidural.

You can ask for a general anaesthetic if you prefer. However, a general anaesthetic carries more risks for you. It also means that you may not be able to breastfeed immediately after the procedure, as there may be traces of the anaesthetic drugs in your breastmilk (RCA nd). Plus, it's best to wait until you feel properly alert again and are able to safely hold your baby (NGC 2012).

Once the anaesthetic is working you'll be taken to the operating theatre. Your midwife or an assistant will lift your legs into stirrups (the lithotomy position). Then your doctor will gently insert her hand to remove the placenta and any remaining membranes from your womb. You'll have intravenous antibiotics to prevent infection, and you'll need more intravenous drugs to help your womb to contract down afterwards (Begley 2014).

What are the symptoms of retained placenta?

If a small piece of placenta is left inside your womb, it will often be passed out through your vagina by itself. You may notice tummy cramps before passing a clot. This could be the remaining placental tissue. If you’re at home and this happens, contact your doctor and let her know what has happened. She may want to see you to make sure your womb has contracted back down.

However, if these fragments don’t pass out of your vagina, you may develop symptoms at home after the birth. These may include:
  • heavy bleeding (Raines nd, HSN nd)
  • tummy cramps (Raines nd)
  • smelly vaginal discharge (Raines nd, HSN nd)
  • fever (HSN nd)
  • a lack of breastmilk (Walker 2011)

Contact your doctor if you have any of these symptoms, especially if you have prolonged, heavy bleeding in the days or weeks following your baby’s birth. Your doctor may refer you for an ultrasound scan (RCOG 2009) to check for fragments of placenta or membrane in your womb.

If any fragments remain, you may need to be admitted to hospital so that they can be removed. This is called evacuation of retained products of conception (ERPC) and is carried out under a regional (spinal) anaesthetic or a general anaesthetic. You'll be given antibiotics to protect you against infection. Your doctor will insert a small instrument through your cervix into your womb and remove the remaining placental tissue.

Some bleeding and cramping is normal after the birth, but if you're worried about any of your postnatal symptoms, get in touch with your doctor.

Can I prevent a retained placenta in my next pregnancy?

Unfortunately, there isn't much you can do to prevent it. If you had a retained placenta in a previous birth, you do have a higher risk of it happening again (Endler et al 2012, Magann et al 2013). But that doesn't mean it will definitely happen.

You're more likely to have a retained placenta if your baby is premature. This may be because the placenta was designed to stay put for 40 weeks. So if you have another premature labour, it may happen again (Endler et al 2012).

However, if the cord snapped, or if your cervix closed too quickly after having the oxytocin injection, you may consider a physiological third stage with your next baby. By allowing the placenta to deliver naturally, you avoid the possibility of the cervix closing too quickly and trapping the placenta. Talk about your options with your doctor.

The prolonged use of syntocinon (artificial oxytocin) during labour has been linked to retained placentas (Endler et al 2012). You may have this if your labour is induced or speeded up. Bear in mind that with your next baby you may not need these interventions at all.

More on labour complications


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Harris T. 2004. Care in the third stage of labour. In: Henderson C, McDonald S. eds. Mayes' midwifery. 13th edition. London: Bailliere Tindall, 507-523.

Hatfield JL, Brumsted JR, Cooper BC. 2006. Conservative treatment of placenta accrete. J Minim Invasive Gynecol 13(6):510-3.

Hoveyda F, MacKenzie IZ. 2001. Secondary postpartum haemorrhage: incidence, morbidity and current management. BJOG 108(9):.927-30.

Magann EF, Evans S, Chauhan SP, et al. 2005. The length of the third stage of labor and the risk of postpartum hemorrhage. Obstetrics and Gynecology 105(2):290–3.

NCCWCH. 2007. Intrapartum care: care of healthy women and
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National Collaborating Centre for Women's and Children's Health. Clinical Guideline. London: RCOG Press. [pdf file 3.09MB; Accessed March 2009]

Prendiville WJP, Elbourne D, McDonald SJ. 2000. Active versus expectant management in the third stage of labour. Cochrane Database of Systematic Reviews. Issue 3. Art. No.: CD000007. [Accessed March 2009]

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Weeks AD. 2008. The retained placenta. Best Pract Res Clin Obstet Gynaecol 22(6):1103-17

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