I am starting this thread to help mummies understand the possible complications of a retained placenta or a fragment of it. This happens in <5% of labour. This thread is a follow-up on my traumatic experience during my post labour period where I had a huge piece of placental tissue retained in me for 2 weeks after labour and this was not detected by my careless obsgyn. You can read the full story here: http://www.mummysg.com/forums/f37/post-labour-horrors-stop-negligent-doctors-73763/#post581810
During third stage labour, when the placenta is delivered, the obsgyn or midwife is responsible for checking thoroughly that the complete piece of placenta and its membranes have been expelled from the uterus.If the placenta does not expel completely or only partially separates, the uterus will not be able to contract properly, and the blood vessels inside will continue to bleed. This is where postpartum haemorrhage usually occurs and the retained placenta/membranes may cause an infection later if it is not detected and removed expediently. So if you have very heavy bleeding, discharge, strong uterine contractions/pain or fever (signs of an infection) after labour, do notify your doctor immediately. These symptoms may not appear immediately and may occur a few days or weeks later.
Below is a standard textbook protocol on how the placenta should be examined during third stage labour. However, in Singapore some doctors argue that these precise steps may not be followed exactly if the obsgyn is experienced enough to gauge if the placenta has expelled completely. So the placental examination is a subjective procedure according to some. I do disagree to a certain extent as I was a victim of a careless obsgyn who thought he knew better and did not check my placenta thoroughly.
Protocol for the inspection of the placenta and membranes during third stage labour:
“The placenta and membranes are held up by the umbilical cord and the fetal surface examined, attention being paid to the blood vessels to see if any run to the edge of the membranes, indicating a possible succenturiate lobe. The membranes are examined to make sure that no part remains in the uterus. The maternal surface of the placenta is examined next; any clots removed/washed away so that the cotyledons can be inspected. The maternal surface is held in both hands and fitted together to make sure that no cotyledon has been left in the uterus. If any cotyledon (lobe) is missing, or if most of the membranes have been left in the uterus or vagina, the doctor should explore the vagina and uterine cavity under sterile conditions after ensuring that the woman has adequate anaesthesia.” (excerpt taken from “Fundamentals of Obstetrics and Gynaecology,” Jeremy Oats and Suzanne Abraham, 8th edition, 2005, Elsevier Mosby, page 82.)
You can also read more on how placenta should be checked from these websites:
Examination of the Placenta - March 1, 1998 - American Academy of Family Physicians
Gross examination of the placenta
I would strongly suggest to all pregnant mummies: do ask your obsgyn or midwife about how they inspect the placenta during third stage labour. Tell them you are concern about placenta retention problem eventhough it may not be very common. I had an uncomplicated pregnancy and labour yet it happened to me. It can be unpredictable. Ensure that the obsgyn and midwife does not carelessly give you an answer or a “model answer” but ask him/her whether they follow the standard inspection protocol during all deliveries regardless of the circumstances. Please do share your obsgyn’s answers here.
During third stage labour, when the placenta is delivered, the obsgyn or midwife is responsible for checking thoroughly that the complete piece of placenta and its membranes have been expelled from the uterus.If the placenta does not expel completely or only partially separates, the uterus will not be able to contract properly, and the blood vessels inside will continue to bleed. This is where postpartum haemorrhage usually occurs and the retained placenta/membranes may cause an infection later if it is not detected and removed expediently. So if you have very heavy bleeding, discharge, strong uterine contractions/pain or fever (signs of an infection) after labour, do notify your doctor immediately. These symptoms may not appear immediately and may occur a few days or weeks later.
Below is a standard textbook protocol on how the placenta should be examined during third stage labour. However, in Singapore some doctors argue that these precise steps may not be followed exactly if the obsgyn is experienced enough to gauge if the placenta has expelled completely. So the placental examination is a subjective procedure according to some. I do disagree to a certain extent as I was a victim of a careless obsgyn who thought he knew better and did not check my placenta thoroughly.
Protocol for the inspection of the placenta and membranes during third stage labour:
“The placenta and membranes are held up by the umbilical cord and the fetal surface examined, attention being paid to the blood vessels to see if any run to the edge of the membranes, indicating a possible succenturiate lobe. The membranes are examined to make sure that no part remains in the uterus. The maternal surface of the placenta is examined next; any clots removed/washed away so that the cotyledons can be inspected. The maternal surface is held in both hands and fitted together to make sure that no cotyledon has been left in the uterus. If any cotyledon (lobe) is missing, or if most of the membranes have been left in the uterus or vagina, the doctor should explore the vagina and uterine cavity under sterile conditions after ensuring that the woman has adequate anaesthesia.” (excerpt taken from “Fundamentals of Obstetrics and Gynaecology,” Jeremy Oats and Suzanne Abraham, 8th edition, 2005, Elsevier Mosby, page 82.)
You can also read more on how placenta should be checked from these websites:
Examination of the Placenta - March 1, 1998 - American Academy of Family Physicians
Gross examination of the placenta
I would strongly suggest to all pregnant mummies: do ask your obsgyn or midwife about how they inspect the placenta during third stage labour. Tell them you are concern about placenta retention problem eventhough it may not be very common. I had an uncomplicated pregnancy and labour yet it happened to me. It can be unpredictable. Ensure that the obsgyn and midwife does not carelessly give you an answer or a “model answer” but ask him/her whether they follow the standard inspection protocol during all deliveries regardless of the circumstances. Please do share your obsgyn’s answers here.
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