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Reoccurrence of retained placenta at vaginal delivery: an observational study
Sys Nikolajsen1, Ellen Christine Leth Løkkegaard, Thomas Bergholt
1Department of Obstetrics & Gynecology, Hillerød Hospital, University of Copenhagen, Hillerød, Denmark. sysnikolajsen@gmail.com
Objective:
To estimate the prevalence and validate the diagnosis of retained placenta in nulliparous women and the risk of reoccurrence at subsequent vaginal delivery.
Design:
Nested cohort study.
Setting:
Department of Gynecology and Obstetrics, university-affiliated teaching hospital.
Population:
10 334 nulliparous singleton pregnancies who delivered vaginally at the hospital during 2000-2009.
Methods:
Data from a computerized database information system were used to identify 287 women who had an ICD-10 diagnosis of retained placenta and 572 randomly selected controls matched by the date of first delivery. At chart review the diagnosis was confirmed by: (1) excessive bleeding <30 minutes after delivery without placental separation, (2) placenta not separated 30 minutes after delivery or (3) confirmation of retained placental tissue >2 hours postpartum.
Main Outcome Measures:
Confirmation of the diagnosis and prevalence of retained placenta. Risk of reoccurrence in a subsequent vaginal delivery.
Results:
The prevalence of retained placenta increased from 2.8 to 7.0% after confirmation according to the set criteria. Of the selected women, 48.4% had a subsequent vaginal delivery. Of these women, 25.3% (23/91) with a previous retained placenta and 5.3% (11/206) without previously retained placenta, experienced retained placenta in subsequent delivery. This corresponds to an adjusted odds ratio of 5.5 (95% confidence interval 2.6-12.7) in the multivariate analysis for recurrence of retained placenta in a subsequent vaginal delivery.
Conclusions:
The use of the ICD-10 diagnosis of retained placenta underestimated the prevalence. The risk of reoccurrence of retained placenta is significantly increased in a subsequent vaginal delivery.
