The placenta is the organ that communicates closely with the mother and the fetus during pregnancy. But it is an ephemeral organ, that is, temporary. As soon as the baby is born, the placenta should be expelled by the organism, since its reason for being was to serve the baby to nourish it, oxygenate it, protect it ... and now it has no function. But sometimes, a rare but dangerous phenomenon occurs: retention of the placenta.
Therefore, professionals who attend the delivery prove that, once expelled, the placenta is whole, that it does not lack any fragment, and the delivery is not terminated until this "second expulsion" is carried out: it is the last phase of labor, delivery.
Typically, the phase of delivery or expulsion of the placenta lasts between five and thirty minutes. After the strong contractions of childbirth, with fatigue from the effort and with the emotion of the arrival of the baby, these milder contractions can go almost unnoticed by the mother. The medical professional helps the mother to perceive them and monitors the expulsion of the placenta.
Placental retention It is one of the complications of the placenta that do not occur during pregnancy but occur after childbirth since this organ has not been expelled with the baby. Let's look at the types of placental retention, the different causes and the risks of this phenomenon.
Retention can occur because there are no contractions (uterine atony, as we see in the following point) or sometimes due to uterine or placental alterations (myomas, malformations ...). Placental retention is more frequent in premature births and also if it is inserted in an unusual place, the cervix (placenta previa).
Even if the placenta is expelled during delivery, a thorough revision of the placenta is very important, since some segment (cotyledon) that has been left inside the uterus or the existence of an accessory placenta ("succenturiata") may be missing. a cotyledon outside the placenta). If one or more cotyledons are forgotten inside the uterus, they can bleed and become infected.
Placental retention: risks
Atony or uterine inactivity, that is, the natural process does not occur whereby, when the woman gives birth, the uterus gradually begins to recover its previous size. If this process of uterine involution does not occur thanks to the postpartum contractions or contractions and due to a series of hormonal changes, the risk of postpartum hemorrhage is increased. The natural thing is that the matrix contracts, squeezing and shrinking, to stop the bleeding of the place where the placenta was on, but if the organism detects that part of it is still in place, the process stops even if the bleeding does occur.
Risk of postpartum hemorrhage, in fact placental retention is indicated as one of the most frequent causes of bleeding after giving birth (together with others such as uterine tear, coagulation failures, inversion of the uterus ...). If a part of the placenta or the entire placenta has already detached but is still in the womb, you can keep it open, with the blood vessels open after the placenta-uterus separation.
Risk of inhibition of milk production (due to the estrogen and the gestagens that the placenta produces). In addition, severe bleeding during or after birth can damage the pituitary gland (Seheenan syndrome) and would also be a cause of hypogalactia.
There are certain signs that indicate that the placenta has already detachedLike a small stream of blood that comes out of the vagina suddenly (and is not continuous), the umbilical cord looks longer and it is detected that the highest part of the garden rises, rises at or above the level of the navel.
If 30 minutes pass after the baby is born and there are still no signs that the placenta has come off, they recommend that the baby has already been breastfed, since when the mother breastfeeds the baby, the uterus contracts and That helps to expel the placenta. It is also recommended to the mother to urinate, since if the bladder is full it could delay the exit of the placenta.
Yes after an hour the placenta has not yet been born by itself or if the mother is bleeding a lot, qualified health professionals will follow different steps so that the irrigation does not increase and extract or leave the placenta.
There is some controversy over whether toilets are to help the placenta leave or let it go out alone and it seems that the latest reviews finally recommend the active management of placental delivery as an initial method, having informed women. Expectant management of the placenta would be a valid option if a woman requests to be treated that way.
In any case, remember that placental retention It is not a frequent phenomenon, it occurs in approximately 0.5% to 1% of births and that even in these cases with proper medical care they will not put the mother's life at risk, with postpartum hemorrhage as a of the most important causes of maternal morbi-mortality in the world.
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More information | Hesperian
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