Retained placenta continues to be fatal but frequency can be reduced

Abstract

Retained placenta is potentially lift-threatening not only because of retention per se , but because of associated haemorrhage and infection as well as complications related to its removal. These risks are increased in women in poor social circumstances due to pre-existing malnutrition, anaemia and unsupervised home deliveries. The present study was undertaken to assess the situation in this rural area. A previous study at the same place suggested preventive strategies an and individualised approach. Incidence of retained placenta has been 0·23% of all births over 15 years. Of the deliveries at Kasturba Hospital, the incidence of retained placenta was 0·008% (two of 23 838 vaginal deliveries). Sixty-five women were admitted with retained placenta after home deliveries and three after delivery at other hospitals The age of most of the patients was between 20 and 29 years and most were para 2 or 3. In twenty-three (32·4%) cases, women had delivered preterm. Twelve (16·9%) women had previous uterine surgery and 10 (14·1%) had had a retained placenta in the past. Twenty-six (36·61%) women had come in a state of severe shock. Thirty-six (50·7%) women required general anaesthesia for manuel removal. One woman with an adherent placenta had to undergo hysterectomy (1·40%). The maternal mortality was 5·6%. Perinatal loss was 7·04%. It is unfortunate that of the four deaths, two women had actually delivered at a near by district hospital and were referred moribund and died. A properly conducted delivery can reduce the incidence of retained placenta and if retention occurs, timely appropriate treatment can save life.