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When Something Goes Wrong With The Placenta

by — Last updated: 2022-03-27 in Pregnancy

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A healthy pregnancy requires a healthy placenta. What can go wrong with the placenta during pregnancy, birth and postpartum — and how are placental problems diagnosed and managed?

Retained Placenta And Placenta Accreta

A retained placenta is, as the name suggests, a complication in which the placenta won't simply detach itself from the uterine wall following labor and birth. The placenta's birth (the so-called "third stage of labor") may take place naturally or be managed during a complication-free labor and delivery.

A placenta should be expelled within an hour of the baby's birth if the third stage is managed naturally, and within half an hour if it was managed with Pitocin, the same drug that is also used to induce or augment labor. 

If you decided to manage your third stage of labor physiologically and your placenta is not coming out, your medical team will generally suggest Pitocin, pushing, or abdominal massage. A placenta, or parts of it, may need to be removed manually in extreme cases. This can be painful, so you will generally be offered general anesthesia for the procedure. 

Placenta accreta is one reason for a placenta to get stuck in the uterus. Placenta accreta is a dangerous placental complication in which the placenta embeds itself into the uterine wall more deeply than usual — all the way through the uterine lining, and into the muscular wall.

This complication places a postpartum mother at great risk of hemorrhage, and it requires surgery to remove the placenta. In some cases, a hysterectomy is the only way to prevent a hemorrhage so severe it would be fatal. 

Placental Insufficiency

Placental insufficiency is a complication in which the blood flow to the placenta is restricted because the placenta is damaged or did not develop properly in the first place. Depending on its severity, placental insufficiency can lead to low-birth weight babies, premature labor and birth, and even birth defects. 

The condition is caused by a reduction in maternal blood supply or if the mother's blood volume did not increase by mid-pregnancy as usually happens. Placental insufficiency can also be the result of diabetes, chronic hypertension, smoking or drug abuse in pregnancy, and the use of certain medications. 

Read More: Overcoming Postpartum Period and Its Difficulties

Placental insufficiency doesn't cause any special symptoms a mother might be concerned about. A small abdomen for gestational age, a baby that doesn't move an awful lot, and restricted growth are possible symptoms. Since placental insufficiency is associated with preeclampsia, placental abruption and intrauterine growth restriction (IUGR), it requires careful monitoring. 

Women who are diagnosed with placental insufficiency will receive more specialized and frequent prenatal care, and their baby may need to be delivered early. 
 
Receiving regular prenatal care throughout your pregnancy is the best way to enable your doctor to spot, diagnose, and manage any complications, including those that affect the placenta. Not only can your baby's growth, as shown on an ultrasound scan, point to placental problems, ultrasound technicians can also get a good look at the placenta itself.