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Chapter 9 - Management of Post-Partum Retained Placental Remnants

Published online by Cambridge University Press:  14 July 2023

By
Mary Connor  and
Priya Madhuvrata
Edited by
Swati Jha  and
Priya Madhuvrata
Swati Jha
Affiliation:
Sheffield Teaching Hospital NHS Foundation Trust
Priya Madhuvrata
Affiliation:
Sheffield Teaching Hospital NHS Foundation Trust
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Summary

Placental remnants following birth are often heralded by secondary post-partum haemorrhage. Diagnosis is assisted by an ultrasound scan, with MRI indicated when the scan is inconclusive. Emergency measures are required for excessive bleeding. A conservative approach is appropriate when bleeding is not heavy. Confirmation of intra-uterine placental tissue by repeated scans ensures surgery is confined to women with a high chance of retained tissue. Traditional curettage is often replaced by hysteroscopic resection allowing direct and precise removal of placental remnants with less trauma to adjacent normal endometrium. Hysteroscopic treatment, under general anaesthetic or as an outpatient, is preferably deferred for 2–3 months after delivery to minimise complications, without compromising longer-term outcomes like fertility or subsequent pregnancy rates. Intra-uterine adhesions may occur especially following repeated blind curettage, which can compromise future fertility. Clear communication with the patient and partner is important. Further research into the management options for postdelivery placental remnants is required to ascertain best practice.

Keywords

post-partum retained products of conceptionplacental remnantssecondary post-partum haemorrhageendometrial thicknessvascularityhysteroscopic resectionintra-uterine adhesions
Type
Chapter
Information
Gynaecology for the Obstetrician , pp. 83 - 94
Publisher: Cambridge University Press
Print publication year: 2023

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