Postpartum retained placental fragments - who is at risk?


      Postpartum retained placental fragments (RPF) are most often clinically manifested as delayed postpartum hemorrhage, or prolonged postpartum spotting. This is a rare complication of labor, yet can potentially cause severe morbidity and discomfort. Evaluation of RPF is based upon clinical manifestations combined with ultrasonography and other imaging techniques. The diagnosis is confirmed by positive histology.
      Most published literature deals with techniques to improve the accuracy of the diagnosis prior to intervention.
      The aim of our study is to identify risk factors for RPF using demographic data and clinical characteristics during labor.

      Study design

      A retrospective case-control analysis of women who underwent surgical removal of tissue, confirmed as RPF. The control group was taken from the delivery room registry of deliveries immediately prior to and following the cases. All women had singleton, term, vaginal deliveries.


      Forty three cases were compared with 76 controls. Demographic and obstetrical data, including: age, parity, gestational age, previous Cesarean section and past miscarriages, demonstrated no statistical difference between the two groups. Women with RPF had significantly higher incidence of interventions during the third stage of delivery including manual removal of placenta and revision of the uterine cavity (28% vs. 5.3% p = 0.001). Additionally, previous history of RPF and infertility were significantly more prevalent among the RPF group (p = 0.002 and p = 0.016, respectively).


      Women that suffer from third stage complications necessitating revision of the uterine cavity are at increased risk for postpartum RPF. This implies the need for greater awareness of the risks associated with these procedures and for improved puerperal surveillance.