In many parts of the developing world, however, the case fatality rate is high. In the last triennial review from the UK there were no deaths from retained placenta in over 2 million deliveries 4. 1, 2, 3 Where there is easy access to hospital care and transfusion, mortality from this condition is very low. Many cases of PPH are associated with retained placenta, a condition that affects between 0.6 and 3.3% of normal deliveries. Post-partum haemorrhage (PPH) is a significant cause of maternal mortality in the developing world. ![]() Further trials are in progress to assess the optimal dose of oxytocin as well as the efficacy of a new technique designed to improve delivery of the oxytocin to the placental bed. This may be due to inadequate delivery of the oxytocin to the placenta. Despite several placebo controlled trials of this technique, no firm conclusion have been reached regarding its efficacy. This method relies on the injected oxytocin passing through the placenta to contract the retro-placental myometrium and cause its detachment. Injection of oxytocin into the umbilical vein has been suggested as an alternative. For women in rural Africa, facilities for MROP are scarce, leading to high mortality rates. This needs to be carried out within a few hours of delivery to avoid haemorrhage. Presently, the only effective treatment is manual removal of placenta (MROP) under anaesthetic. It is likely that this is caused by the persistence of one of the placental inhibitory factors that are normally reduced prior to the onset of labour, possibly progesterone or nitric oxide. There is evidence that this may also occur during labour leading to dysfunctional labour. Retained placenta occurs when the retro-placental myometrium fails to contract. It is only when it contracts that the placenta shears away from the placental bed and is detached. ![]() Following delivery of the baby, the retro-placental myometrium is initially relaxed. Ultrasound studies have provided fresh insights into the mechanism of the third stage of labour and the aetiology of the retained placenta. ![]() It complicates 2% of all deliveries and has a case mortality rate of nearly 10% in rural areas. The retained placenta is a significant cause of maternal mortality and morbidity throughout the developing world.
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