Describe the presentation and treatment of retained placenta.
Retained placenta occurs in about 1 in 300 deliveries and is characterized by painless vaginal bleeding following delivery. Treatment goals focus on manually removing the placenta, which prevents uterine contractions. Dilatation and curettage may be required to evacuate the uterus.
Abnormal implantation in the uterus, such as placenta accreta, placenta increta, or placenta percreta, may make removal of the placenta impossible. Hysterectomy, hypogastric artery ligation, or arterial embolization may be lifesaving maneuvers.
For the anesthesiologist, maternal resuscitation is the first priority. Intravenous sedation usually suffices for evacuation of the uterus. Hysterectomy or hypogastric artery ligation requires general anesthesia, the manage-ment of which is similar to that described above.