For gestations at 20 and 30 weeks to achieve a 90 percent spontaneous placental delivery rate, a life-table analysis predicted it would take 180 and 21 minutes, respectively. The frequency of retained placenta is 3-fold higher in preterm gestations compared with term gestations, particularly in the second trimester when the risk is 21-fold higher compared with term gestations ( figure 2). Physiologic management of the third stage (ie, delivery of the placenta without the use of uterotonic agents or cord traction) increases the frequency of retained placenta: only 80 percent of placentas are expelled by 30 minutes ( figure 1) and it takes approximately 60 minutes before 98 percent of placentas are expelled. This is a reasonable definition in the third trimester when the third stage of labor is actively managed (ie, administration of a uterotonic agent before delivery of the placenta, controlled cord traction) because 98 percent of placentas are expelled by 30 minutes in this setting ( figure 1). (See "Retained products of conception in the first half of pregnancy".)ĭEFINITION - Retained placenta can be defined as lack of expulsion of the placenta within 30 minutes of birth of the neonate. Management of retained products of conception after a miscarriage or pregnancy termination is reviewed separately. This topic will discuss the diagnosis and management of a retained placenta after vaginal birth. Delayed placental separation and expulsion is a potentially life-threatening event because it impedes normal postpartum uterine contraction, which can lead to hemorrhage. INTRODUCTION - The third stage of labor is the interval from the birth of the neonate to expulsion of the placenta.
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