What are retained products of conception?
Retained products of conception (RPOC) is a term used to describe placenta and/or foetal tissues that remains in the uterus following childbirth, medical termination of pregnancy or a miscarriage. RPOC can be caused when the uterus stops contracting which means that the placenta is not delivered or is only partially delivered. This condition is known as uterine atony.
As retained products of conception can cause women serious health problems, it is essential that after childbirth the midwife examines the placenta carefully to check that it is complete and that no tissue has been left behind. Where a child has been delivered by caesarean section, it is essential that in addition to checking the placenta, the obstetrician examines the womb before suturing, to ensure none of the placenta is left behind. If the midwife or obstetrician fails to check the placenta correctly, resulting in retained product, you may have a claim in medical negligence*.
Types of retained placenta
- Placenta adherents. This is when the placenta does not spontaneously separate from the uterus within 30 minutes of the baby being born. This is the most common type of retained placenta.
- Trapped placenta. This occurs when the placenta separates from the uterus, but does not spontaneously leave the uterus.
- Placenta accreta. This is the most dangerous type of retained placenta. It occurs when the placenta grows into the deeper layer of the uterus and is unable to spontaneously detach. This condition is more common where a woman has had a previous caesarean section delivery; or has had multiple pregnancies; or where there is womb scarring from a previous surgery; or where the placenta is low lying.
Placenta accreta is a very serious condition and can lead to a hysterotomy or a blood transfusion.
Risks of RPOC are greater in termination and miscarriages.
It is much more difficult to determine whether a patient has retained products of conception in terminations and miscarriages, as the placenta and foetal tissue has already been expelled from the womb. In the UK, RPOC are reported in 17% of first trimester miscarriages and 40% of second trimester miscarriages, as opposed to 3% at full term deliveries. If you are dealing with a miscarriage, may we offer your are sincere condolences. The HSE has further information on dealing with the aftermath of a miscarriage’s, which you may find helpful.
What are the Risks of Retained Products of Conception?
If left untreated, RPOC can cause infection and/or sepsis, which can be life threatening. It can also have implications on fertility and can make you more susceptible to future miscarriages.
What are the symptoms of Retained Products of Conception?
Heavy and prolonged vaginal/uterine bleeding
After childbirth, a termination or a miscarriage some bleeding is normal. However, if this bleeding is very heavy or prolonged, you should seek immediate medical attention, as this could be a sign of RPOC. Heaving bleeding, is that which is significantly heavier than your normal period and prolonged bleeding, is bleeding that continues for longer than three weeks.
If your period does not return within six weeks of childbirth, termination or miscarriage, it may be a symptom of RPOC and you should medical attention.
Fever, pelvic pain or tenderness.
These can be symptoms not only of RPOC, but can also be signs of severe infection and require immediate medical attention. It is important to note that in certain instances RPOC can lead to sepsis, which is a life-threatening condition.
How is RCOP diagnosed
Ideally the RPOC should be spotted when the placenta is examined. Thereafter, there are a number of tests that can be done, including physical examinations, ultrasounds or hysteroscopy.
If spotted early RPOC can often be dealt with by medication which encourages the uterus to expel the retained products. However, in certain cases it may require surgery under general anaesthetic.
RPOC medical negligence claims
The mere fact that you have been left with RPOC after childbirth, miscarriage or termination, does not, in and of itself mean that you have claim in medical negligence*. This will depend primarily on two factors:
- The size of the RPOC left in the uterus; and
- The length of time it has taken for the condition to be diagnosed.
As with all medical negligence claims*, the matter will depend entirely on the individual facts of each case. If you are concerned about your treatment with respect to RPOC and particularly where you have been unwell, we would suggest you contact an expert medical negligence solicitor*.
Hanahoe & Hanahoe have over 40 years’ experience in dealing with medical negligence claims* and represents clients from all across the country.
*In contentious business, a solicitor may not calculate fees or other charges as a percentage or proportion of any award or settlement.