Predicting retained placenta after vaginal delivery

  • Eur J Obstet Gynecol Reprod Biol

  • curated by Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Risk factors for retained placenta after vaginal delivery include higher maternal age, longer oxytocin use, postpartum hemorrhage.

Why this matters

  • Retained placenta complicates 0.5%-3% of all vaginal deliveries and is associated with hemorrhage, infection, and prolonged hospitalization.
  • Exact etiology is not known.

Key results

  • The rate of retained placenta was 0.6%.
  • Women with a higher maternal age (P=.011), labor induction with prostaglandins (P=.014), longer use of oxytocin (P=.048), instrumental delivery (P=.0001), history of uterine curettage (P=.016), and postpartum hemorrhage (P=.0001) had a higher rate of retained placenta.
  • Lower birth weight (P=.01), lower 1-minute Apgar score (P=.0001), and lower placental weight (P=.0001) were associated with increased risk for retained placenta.
  • There were no differences in rate of retained placenta with history of cesarean delivery or fertility treatments.
  • A predictive model with a cutoff score fixed at 61.8 has a sensitivity of 76.3% and a specificity of 75.8%.

Study design

  • Retrospective case-control study between 2007 and 2017 in 2 institutions.
  • Women with retained placenta after vaginal delivery were identified using ICD codes (n=138).
  • Risk factors for retained placenta were identified.
  • A predictive model to predict retained placenta was created.
  • Funding: None.

Limitations

  • Retrospective design.
  • Predictive model needs validation.

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