Retained placenta and placenta accreta

Question 1

When is retained placenta suspected?

Answer 1

If not delivered within 30 minutes in an actively managed 3rd stage and within 1 hour in a physiologically managed 3rd stage

Question 2

Mx if 3rd stage physiologically managed

Answer 2

Revert to active management and give Synometrine/Oxytocin

Question 3

Mx if 3rd stage was actively managed

Answer 3

Injection of 20 IU of oxytocin into the umbilical vein

Question 4

Placenta accreta

Answer 4

Placental villi are attatched to the myometrium

Question 5

Placenta increta

Answer 5

Villi invade into the myometrium

Question 6

Placenta perceta

Answer 6

Pass through the myometrium into the serosa and may involve other structures

Question 7

Mx of placenta accreta post delivery if heavy bleeding

Answer 7

1. Replace blood
2. Tamponade with balloon
3. Hysterectomy