Retained placenta

babyktchr, BSN, RN · Aug 3, 2005

Sometimes when there is an early gestation loss...the placenta just hangs on in there depending on the circumstance of the demise. If the fetus was "dead" a while, the placenta more often comes out more quickly. If the fetus was alive during the delivery, they hang on. I have seen docs wait hours for a placenta to detach, but in the absence of heavy bleeding. If your patient was passing clots and bleeding heavily, perhaps a D&C would've been the more reasonable approach at an earlier time.

midwife2b · Aug 4, 2005

Sometimes when there is an early gestation loss...the placenta just hangs on in there depending on the circumstance of the demise. If the fetus was "dead" a while, the placenta more often comes out more quickly. If the fetus was alive during the delivery, they hang on. I have seen docs wait hours for a placenta to detach, but in the absence of heavy bleeding. If your patient was passing clots and bleeding heavily, perhaps a D&C would've been the more reasonable approach at an earlier time.

Yes, second trimester placentas take a while to detach. We occasionally use a very high dose pitocin protocol and in the absence of heavy bleeding and unstable vitals, we'd pit the mom for up to 18 hrs (gotta watch for water intox though).

The last two demises I was involved with, we used 800 mcg. of cytotec rectally. Placentas came out easily in less than an hour. Gave the parents time to bond with the baby vs. feeling like it wasn't over yet.