To determine outcome of patients presenting with retained placenta.
Patients and Methods
This descriptive study was carried out at Department of Obstetrics and Gynecology, Jinnah Post Graduate Medical Center (JPMC), Karachi from 1st February 2007 to 31st January 2009.
A total of 65 patients with retained placenta were included in this study. The average age was 29.8+7.2 years. Out of these, 26 (40%) were booked and 39 (41.5%) were multiparae while 18 (27.6%) were grandmultipare. Average parity was 4.6+1.8 (95% CI: 3.5 to 6.2). Twenty two (33.8%) patients were delivered at home and 43 (66.2%) were delivered at hospital, 22 delivered out side JPMC and 21 at JPMC. Thirty four (52%) deliveries were conducted by Dai, 28 (43%) by doctors and 3 (5%) by nurses. Regarding causative factors, in 19 (29.2%) patients augmentation, in 1 (1.5%) case uterine atony, in 1 (1.5%) case morbidly adherent placenta (placenta percreta) and in 8 (12.3%) adherent membranes were seen.
Anemia was the most common clinical presentation, seen in 32 (49.2%) patients, severe PPH in 10 (15.4%) patients, PPH and shock in 6 (9.2%) patients and 2 (3.1%) had pregnancy induced hypertension. Seventeen patients (26.2%) had spontaneous vaginal delivery without augmentation of labor. Duration of 3rd stage of labor was 1 to 3 hours in 23 (34.4%) patients, while in 42 (64.6%) patients was 4-6 hours. Massive blood transfusions (8-20 pints), were given in 63 (96.9%) cases. No maternal mortality occurred in the study.
Most common contributing factor for increasing the rate of retained placenta was mismanagement of third stage of labor. History of previous caesarean section or placenta percreta, increta, accrete can cause severe hemorrhage and ultimately hysterectomy or results in maternal mortality. (Rawal Med J 2011;36:301-304).
Retained placenta, placenta, percreta, PPH.