Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Archives of Gynecology and Obstetrics
Published in: Archives of Gynecology and Obstetrics 2/2018

01-02-2018 | Maternal-Fetal Medicine

Failed manual removal of the placenta after vaginal delivery

Authors: Johanna Bjurström, Sally Collins, Jens Langhoff-Roos, Karin Sundberg, Annemette Jørgensen, Johannes J. Duvekot, Lene Groenbeck, For the EW-AIP

Published in: Archives of Gynecology and Obstetrics | Issue 2/2018

Login to get access

Abstract

Purpose

A retained placenta after vaginal delivery where manual removal of placenta fails is a clinical challenge. We present six cases that illustrate the heterogeneity of the condition and discuss the etiology and terminology as well as the clinical management.

Methods

Members of the European Working group on Abnormally Invasive Placenta (EW-AIP) were invited to report all recent cases of retained placenta that were not antenatally suspected to be abnormally adherent or invasive, but could not be removed manually despite several attempts.

Results

The six cases from Denmark, The Netherlands and the UK provide examples of various treatment strategies such as ultrasound-guided vaginal removal, removal of the placenta through a hysterotomy and just leaving the placenta in situ. The placentas were all retained, but it was only possible to diagnose abnormal invasion in the one case, which had a histopathological diagnosis of increta. Based on these cases we present a flow chart to aid clinical management for future cases.

Conclusion

We need properly defined stringent terminology for the different types of retained placenta, as well as improved tools to predict and diagnose both abnormally invasive and abnormally adherent placenta. Clinicians need to be aware of the options available to them when confronted by the rare case of a retained placenta that cannot be removed manually in a hemodynamically stable patient.
Literature
1.
Evensen A, Anderson JM, Fontaine P (2017) Postpartum hemorrhage: prevention and treatment. Am Fam Physician 95(7):442–449PubMed
2.
Herman A (2000) Complicated third stage of labor: time to switch on the scanner. Ultrasound Obstet Gynecol 15(2):89–95CrossRefPubMed
3.
Collins SL, Stevenson GN, Al-Khan A, Illsley NP, Impey L, Pappas L et al (2015) Three-dimensional power Doppler ultrasonography for diagnosing abnormally invasive placenta and quantifying the risk. Obstet Gynecol 126(3):645–653CrossRefPubMed
4.
Bennett MJ, Townsend L (2009) Conservative management of clinically diagnosed placenta accreta following vaginal delivery. Aust N Z J Obstet Gynaecol 49(6):647–649CrossRefPubMed
5.
Lee D, Johnson J (2012) Hysterotomy for retained placenta in a septate uterus: a case report. Case Rep Obstet Gynecol 2012:594140PubMedPubMedCentral
6.
Shekhar S, Verma S, Motey R, Kaushal R (2010) Hysterotomy for retained placenta with imminent uterine rupture in a preterm angular pregnancy. Acta Obstet Gynecol Scand 89(12):1615–1616CrossRefPubMed
7.
Silver RM, Barbour KD (2015) Placenta accreta spectrum: accreta, increta, and percreta. Obstet Gynecol Clin North Am 42(2):381–402CrossRefPubMed
8.
Sentilhes L, Ambroselli C, Kayem G, Provansal M, Fernandez H, Perrotin F et al (2010) Maternal outcome after conservative treatment of placenta accreta. Obstet Gynecol 115(3):526–534CrossRefPubMed
9.
Chongsomchai C, Lumbiganon P, Laopaiboon M (2014) Prophylactic antibiotics for manual removal of retained placenta in vaginal birth. Cochrane Database Syst Rev 10:CD004904
10.
Endler M, Grunewald C, Saltvedt S (2012) Epidemiology of retained placenta: oxytocin as an independent risk factor. Obstet Gynecol 119(4):801–809CrossRefPubMed
11.
Owolabi AT, Dare FO, Fasubaa OB, Ogunlola IO, Kuti O, Bisiriyu LA (2008) Risk factors for retained placenta in southwestern Nigeria. Singap Med J 49(7):532–537
12.
Adelusi B, Soltan MH, Chowdhury N, Kangave D (1997) Risk of retained placenta: multivariate approach. Acta Obstet Gynecol Scand 76(5):414–418CrossRefPubMed
13.
Combs CA, Laros RK Jr (1991) Prolonged third stage of labor: morbidity and risk factors. Obstet Gynecol 77(6):863–867PubMed
14.
Coviello EM, Grantz KL, Huang CC, Kelly TE, Landy HJ (2015) Risk factors for retained placenta. Am J Obstet Gynecol 213(6):864 e1–864 e11CrossRef
15.
Ashwal E, Melamed N, Hiersch L, Wiznitzer A, Yogev Y, Peled Y (2014) The incidence and risk factors for retained placenta after vaginal delivery—a single center experience. J Matern Fetal Neonatal Med 27(18):1897–1900CrossRefPubMed
16.
Belachew J, Cnattingius S, Mulic-Lutvica A, Eurenius K, Axelsson O, Wikstrom AK (2014) Risk of retained placenta in women previously delivered by caesarean section: a population-based cohort study. BJOG 121(2):224–229CrossRefPubMed
17.
Panpaprai P, Boriboonhirunsarn D (2007) Risk factors of retained placenta in Siriraj Hospital. J Med Assoc Thai 90(7):1293–1297PubMed
18.
Chan YY, Jayaprakasan K, Zamora J, Thornton JG, Raine-Fenning N, Coomarasamy A (2011) The prevalence of congenital uterine anomalies in unselected and high-risk populations: a systematic review. Hum Reprod Update 17(6):761–771CrossRefPubMedPubMedCentral
19.
Chan YY, Jayaprakasan K, Tan A, Thornton JG, Coomarasamy A, Raine-Fenning NJ (2011) Reproductive outcomes in women with congenital uterine anomalies: a systematic review. Ultrasound Obstet Gynecol 38(4):371–382CrossRefPubMed
20.
Fox NS, Roman AS, Stern EM, Gerber RS, Saltzman DH, Rebarber A (2014) Type of congenital uterine anomaly and adverse pregnancy outcomes. J Matern Fetal Neonatal Med 27(9):949–953CrossRefPubMed
21.
Hiersch L, Yeoshoua E, Miremberg H, Krissi H, Aviram A, Yogev Y et al (2016) The association between Mullerian anomalies and short-term pregnancy outcome. J Matern Fetal Neonatal Med 29(16):2573–2578PubMed
22.
Vaz SA, Dotters-Katz SK, Kuller JA (2017) Diagnosis and management of congenital uterine anomalies in pregnancy. Obstet Gynecol Surv 72(3):194–201CrossRefPubMed
23.
Wright CE, Chauhan SP, Abuhamad AZ (2014) Bakri balloon in the management of postpartum hemorrhage: a review. Am J Perinatol 31(11):957–964CrossRefPubMed
24.
Doumouchtsis SK, Papageorghiou AT, Arulkumaran S (2007) Systematic review of conservative management of postpartum hemorrhage: what to do when medical treatment fails. Obstet Gynecol Surv 62(8):540–547CrossRefPubMed
25.
Georgiou C (2009) Balloon tamponade in the management of postpartum haemorrhage: a review. BJOG 116(6):748–757CrossRefPubMed
26.
Kayem G, Kurinczuk JJ, Alfirevic Z, Spark P, Brocklehurst P, Knight M (2011) Specific second-line therapies for postpartum haemorrhage: a national cohort study. BJOG 118(7):856–864CrossRefPubMed
27.
Laas E, Bui C, Popowski T, Mbaku OM, Rozenberg P (2012) Trends in the rate of invasive procedures after the addition of the intrauterine tamponade test to a protocol for management of severe postpartum hemorrhage. Am J Obstet Gynecol. 207(4):281 e1–281 e7CrossRef
28.
Revert M, Cottenet J, Raynal P, Cibot E, Quantin C, Rozenberg P (2016) Intrauterine balloon tamponade for management of severe postpartum haemorrhage in a perinatal network: a prospective cohort study. BJOG 124(8):1255–1262. doi:10.​1111/​1471-0528.​14382 CrossRefPubMed
29.
D’Antonio F, Palacios-Jaraquemada J, Lim PS, Forlani F, Lanzone A, Timor-Tritsch I et al (2016) Counseling in fetal medicine: evidence-based answers to clinical questions on morbidly adherent placenta. Ultrasound Obstet Gynecol 47(3):290–301CrossRefPubMed
30.
Ruiz Labarta FJ, Pintado Recarte MP, Alvarez Luque A, Joigneau Prieto L, Perez Martin L, Gonzalez Leyte M et al (2016) Outcomes of pelvic arterial embolization in the management of postpartum haemorrhage: a case series study and systematic review. Eur J Obstet Gynecol Reprod Biol 206:12–21CrossRefPubMed
31.
Cirpan T, Sanhal CY, Yucebilgin S, Ozsener S (2011) Conservative management of placenta previa percreta by leaving placental tissue in situ with arterial ligation and adjuvant methotrexate therapy. J Turk Ger Gynecol Assoc 12(2):127–129CrossRefPubMedPubMedCentral
32.
Heiskanen N, Kroger J, Kainulainen S, Heinonen S (2008) Placenta percreta: methotrexate treatment and MRI findings. Am J Perinatol 25(2):91–92CrossRefPubMed
33.
Lalchandani S, Geary M, O’Herlihy C, Sheil O (2003) Conservative management of placenta accreta and unruptured interstitial cornual pregnancy using methotrexate. Eur J Obstet Gynecol Reprod Biol 107(1):96–97CrossRefPubMed
34.
Mussalli GM, Shah J, Berck DJ, Elimian A, Tejani N, Manning FA (2000) Placenta accreta and methotrexate therapy: three case reports. J Perinatol 20(5):331–334CrossRefPubMed
35.
Pinho S, Sarzedas S, Pedroso S, Santos A, Rebordao M, Avillez T et al (2008) Partial placenta increta and methotrexate therapy: three case reports. Clin Exp Obstet Gynecol 35(3):221–224PubMed
36.
Lim BH, Palacios-Jaraquemada JM (2015) The morbidly adherent placenta—a continuing diagnostic and management challenge. BJOG 122(12):1673CrossRefPubMed
37.
Tikkanen M, Paavonen J, Loukovaara M, Stefanovic V (2011) Antenatal diagnosis of placenta accreta leads to reduced blood loss. Acta Obstet Gynecol Scand 90(10):1140–1146CrossRefPubMed
38.
Bhide A, Sebire N, Abuhamad A, Acharya G, Silver R (2017) Morbidly adherent placenta: the need for standardization. Ultrasound Obstet Gynecol 49(5):559–563CrossRefPubMed
39.
Thurn L, Lindqvist PG, Jakobsson M, Colmorn LB, Klungsoyr K, Bjarnadottir RI et al (2016) Abnormally invasive placenta-prevalence, risk factors and antenatal suspicion: results from a large population-based pregnancy cohort study in the Nordic countries. BJOG 123(8):1348–1355CrossRefPubMed
Metadata
Title
Failed manual removal of the placenta after vaginal delivery
Authors
Johanna Bjurström
Sally Collins
Jens Langhoff-Roos
Karin Sundberg
Annemette Jørgensen
Johannes J. Duvekot
Lene Groenbeck
For the EW-AIP
Publication date
01-02-2018
Publisher
Springer Berlin Heidelberg
Published in
Archives of Gynecology and Obstetrics / Issue 2/2018
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-017-4579-2

Other articles of this Issue 2/2018

Archives of Gynecology and Obstetrics 2/2018 Go to the issue

News and Views

Changes in classification of genetic variants in BRCA1 and BRCA2

Gynecologic Endocrinology and Reproductive Medicine

Assessment of ovarian function after chemotherapy in women with early and locally advanced breast cancer from Serbia

Gynecologic Oncology

Diagnostic performance of HPV E6/E7 mRNA assay for detection of cervical high-grade intraepithelial neoplasia and cancer among women with ASCUS Papanicolaou smears

General Gynecology

Antenatal corticosteroids administration: are we giving them at the right time?

Gynecologic Endocrinology and Reproductive Medicine

Effect of intramural fibroid on uterine and endometrial vascularity in infertile women scheduled for in-vitro fertilization

Gynecologic Endocrinology and Reproductive Medicine

What is the net effect of introducing vitrification for cryopreservation of surplus 2PN oocytes in an IVF program?