Retained placenta and PPH with DC1, advice for DC2 please.

(11 Posts)

With DD I had assisted delivery (ventouse) after a fairly long labour, managed third stage, then retained placenta and PPH (1600ml.) I ended up with a spinal block to allow manual removal and my discharge note mentioned 'ragged membranes'??

I am 32 weeks with DC2 and considering my options. My CMW has recommended that I have a managed third stage again, but I'm not clear in my own mind really whether this would be beneficial or not in terms of avoiding another retained placenta/PPH.

I do know that last time my bladder was really really full, and mw has suggested that this may have been part of the reason for retained placenta.

I know there is another similar thread on the go at the mo, but my circumstances are slightly different and didn't want to hijack that thread. Any help or advice would be very much appreciated.

Thanks.

pepperrabbit Thu 24-Jan-13 22:21:31

I had a retained placenta and manual removal exactly as you say, with DC2 I asked about a natural third stage and the midwife's exact words were "not a chance". I remember it distinctly! but all was well with a managed 3rd stage and they were fully aware of my history, in fact I had no stitches at all that time.
I actually turned out to have something called a velamentous insertion where the cord attaches to the placenta in the wrong place (hazy medical detail).
I was much more in control with DC2, I think with DC1 I just did as I was told, so maybe being more aware of what was going on helped?
DC3 was a doddle smile and I never had MROP again.

idlevice Fri 25-Jan-13 00:08:32

I had MROP under GA & PPH after DS1, it was a long back-to-back labour with syntocinon & no pain relief so the whole thing was hellish. I lost 3litres & it put the fear into me as that's half your blood volume so I was happy enough to go with what was recommended by my drs the second time round, but not blindly of course. For DS2 I had a reasonably straightforward labour under epidural, had the injection, lost "only" 1litre & had a scan very soon after delivery to ensure nothing remained in utero.

I was theorectically interested in delayed cord clamping but although the dr was open to this routinely they didn't want to take any chances & I was fine with that.

It is very much an individual thing of course but I would be guided by medical advice in the first instance. Wrt risk of PPH check you don't have any predisposition to bleeding like a blood clotting disorder & make sure you are not anaemic prior to delivery (which would be sensible anyway).

Flisspaps Fri 25-Jan-13 03:29:01

I had PPH and MROP with DD.

With DS I planned a homebirth with physiological third stage. My main concern was avoiding a second MROP, and the injection can cause the cervix to close before the placenta is delivered.

As it happened, I ended up in theatre with forceps and another
PPH.

However, it's possible to wait and see and have the syntometrine if you need it, rather than just in case. It only takes seconds to work.

Fresh01 Fri 25-Jan-13 12:49:04

I had a PPH and retained placenta with DC1. Lost 1 litre of blood in PPH as she tore my cervix coming out. Retained placenta not discovered till 10 weeks later and had a D&C under general.

DC2, I wasn't allowed in water at all and they insisted on a canula being in in early stages of labour. I have really thin wiggly blood vessels! No PHH with DC2 but did have retained placenta which was detected less than an hour after birth as I was loosing quite a bit of blood. Trip to theatre with a general for manual removal.

DC3 no PPH and no retained placenta - also only boy baby!

DC4 no PPH but got flu symptoms after 3 weeks and given antibiotics for mastitis or retained placenta. A few days later I passed a large chunk of placenta at home.

All fairly straight forward births with only gas and air for 3 of them. After DC1 they always insisted of managed 3rd stage.

Thanks ladies. Really useful to hear your stories.

Think ill probably go with mw's suggestion. Hopefully this time it'll be more straightforward, but you never know! Thanks again.

Emsyboo Sat 26-Jan-13 17:32:18

I was the same as fresh PPH and retained placenta discovered after 8 days when placenta was so infected it spread to my kidneys and I was rushed to a&e they gave me antibiotics and 2 weeks later back in it took 6 weeks of hospital admissions and illness before they did a D&C
Getting pregnant again they didn't see a problem at first could have water birth but may need to get out straight away. Nothing mentioned about assisted 3rd stage to me which is odd unless they were waiting till later to discuss.
As it turns out all the infections from retained placenta caused a lot if scarring and I now have placenta previa as there were few places for placenta to attach so having ELCS.
Needless to say they are treating me very well after leaving it do long to sort last time!

beckie90 Sun 27-Jan-13 14:02:54

I had the same problem with ds1, was induced and started bleeding as soon as my labour started I wasnt allowed to move and had toay down with pads under me all the duration of it, luckily it only lasted 5hrs, he was out very quickly (no assitance needed) but once out I started bleeding very very bad, I lost 2litres after the birth and the loss that I had during labour was guessed at 500ml which I doubt was right, as my midwife had to leave the room most of the time, and my partner and mother was left to keep changing my pads every 15mins. After a few days in HDU I was discharged and then seemed fine, until my bleeding over the next few week got worse nor better, I was admitted back to hospital with retained products.

Ds2 labour was totally different, it was long and went on for 5 days and was more painful then ds1 (back to back) I had to have help getting him out 2hrs of pushing wasn't enough. Placenta wouldnt come away without a fight, the doctor was kneeding at my tummy trying to encourage it then he gently pulled on the cord bit (which I was thinking wth) eventually it comd out, no retained products and only a 300ml blood loss smile so ds2 was a long n painful labour but much better than ds1.

Pregnant with my 3rd now, and still scared even though I had a normal 2nd birth xx

galwaygirl Sun 27-Jan-13 14:10:40

I had a similar experience with DD and am pregnant again and have been worried about the likelihood of retained placenta and PPH again. My consultant said the risk is higher but not guaranteed. My MW said they probably advise me to have a managed third stage but not clear how that would make any difference as I opted for this first time and it wouldn't come out. The memory of them pulling it out while I was inching along the bed towards them numb from the chest down from the spinal is up there with my top shit memories of the birth - felt like an animal.
Think I'm best to prepare myself for it happening again going by the replies above... Best start on the iron tablets soon!

Longdistance Sun 27-Jan-13 14:17:51

I had a retained placenta with dd1. It was probably due to the fact that the umbilical cord was only 15cm.......yes, you did read that right. It was extremely short. We were very lucky as she could have been smothered in the birth canal, but she shot out, and it was all quick.
MW had a stunned face on her s the cord snapped, and we waited for the placenta to appear. I did request the drug on my birthing notes. We waited at least half an hour, and they were ready to prep me for surgery, when the doc started to press on my tummy ouch, and it eventually came out whole and intact.
I'd defo make plans on the birth plan. I requested that if the dd2 was breech she was not to be moved because of the previous short cord.

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