Retained placenta and postpartum hemorrhage: time is not everything

Area of Science:

• Obstetrics and Gynecology
• Maternal Health
• Hemorrhage Management

Background:

• Postpartum hemorrhage (PPH) is a leading cause of maternal mortality globally.
• Retained placenta contributes to nearly 20% of severe PPH cases.
• Understanding PPH dynamics in retained placenta is crucial for improving outcomes.

Purpose of the Study:

• To investigate the influence of time and retained placenta etiology on PPH dynamics.
• To determine the relationship between third stage of labor duration and blood loss.
• To analyze factors associated with increased PPH in retained placenta cases.

Main Methods:

• Retrospective analysis of 296 women with retained placenta.
• Accurate blood loss measurement using calibrated bags and hemoglobin decrease.
• Spearman correlation and subgroup analysis of third stage duration and etiology.

Main Results:

• No correlation found between third stage duration and measured blood loss or hemoglobin decrease.
• Shorter third stage (<60 min) linked to increased uterine atony and blood transfusion needs.
• Uterine atony strongly associated with greater blood loss, PPH, and transfusion requirements.

Conclusions:

• Third stage duration does not predict postpartum blood loss in retained placenta.
• No safe time window for PPH; early manual placenta removal not always justified.
• Prompt detection of uterine atony is critical for effective PPH management.