Retained Placental Piece and Hemorrhage

I had a hemorrhage at 4 weeks post partum. I was rushed in for an emergency D&C but lost approx. a third of my blood. I have recovered now but I still don't understand how this happened. My doctor explained that a piece of placenta was left behind, it attached to my uterus and caused the bleeding. This was the scariest thing to ever happen to me and I can't help but have fear it will happen again now or in future pregnancies. Both my doctor and nurse practitioner said it was a fluke and it is highly unlikely it will happen in future pregnancies. I have tried to do research so that I could read about this and better understand what happened but can't find any info.

Is it possible that you could provide me with more info or at least point me to some resources that might help?



Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

Dear Jackie,

This is known as "late postpartum hemorrhage" and it is indeed a rare, chance event. A piece of placental tissue continues to be supported with blood and then when it breaks free, the site continues to bleed. I think we actually underestimate the occurrence of "retained placental fragments" because in most cases, it causes just a momentary increase in flow and the woman does not experience what you did.

After the expulsion of the placenta, one of the tasks of the care provider is to examine the placenta to see if any "cotyledons" or lobes are missing. This can happen especially if the midwife or physician needs to do a manual removal of the placenta or if there is some delay in placental expulsion or removal. Inspecting the placenta, however, does not always guarantee that the missing piece will be identified but it increases the likelihood.

Another sign of retained fragments that we watch for is increased bleeding in the early postpartum period or "subinvolution" of the uterus where the uterus fails to shrink back down in a typical manner. In this event, we give a medication such as methergine to try to make the uterus contract and expel any fragments.

Retained placental fragments may result in difficulty in lactation also as well as put the woman at risk for infection.

Women who deliver prematurely are at higher risk for this event but for most it is a chance thing and it generally does not recur.

I hope you feel reassured and I'm glad you are back to normal now. I wish you the best.

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