Retained Placenta

A retained placenta is defined by many providers as no delivery within 30 minutes (with active management) or 60 minutes (with physiologic management). Options include continued watchful waiting, additional uterotonic, bladder emptying, breastfeeding to boost oxytocin, and — if bleeding or timing warrants — manual removal in the OR under anesthesia.

Each link opens the full review on the publisher's site in a new tab.

• ACOG Practice Bulletin 183: Postpartum Hemorrhage↗ACOG
• WHO recommendations on prevention and treatment of postpartum haemorrhage↗WHO

• ·Timely intervention prevents severe blood loss and infectionReview sources ↓

• ·Manual removal requires anesthesia and carries small risk of infection or uterine traumaReview sources ↓
• ·Placenta accreta spectrum (placenta attached too deeply) may be diagnosed at this pointReview sources ↓

• ·Wait with close observation if bleeding is minimal and vitals stableReview sources ↓
• ·Attempt maternal effort in an upright position, or breastfeeding for oxytocin releaseReview sources ↓
• ·Uterotonic redosingReview sources ↓
• ·Manual removal in the ORReview sources ↓

ACOG Practice Bulletin 183 and WHO PPH guidance address management. About 1–3% of vaginal births involve retained placenta.

For most topics, guidelines from ACOG, WHO, and other major bodies broadly agree on the core safety points (when to act in an emergency, informed-consent standards, monitoring baselines). Where reasonable people — and even guidelines — differ tends to be around thresholds (when to start or stop something), preferences (comfort, environment, support), and values (how you weigh small risks against benefits). Use the questions below to explore those pieces with your care team.

Educational only. Your care team can help you weigh what applies to your specific situation.

• Delivering the PlacentaThe placenta usually comes out on its own within 5–30 minutes after the baby, with a small gush of blood and a mild contraction. What signs mean it's ready, what your team is watching for, and what to expect physically.
• Postpartum Hemorrhage (PPH)Bleeding of ≥ 500 mL after vaginal birth or ≥ 1000 mL after cesarean — or any bleeding making you unstable. Most PPH is treatable when caught fast. Every U.S. birthing unit now runs a standardized 'hemorrhage bundle' with clear escalation steps.
• Active Management of the Third StageA three-part package: prophylactic uterotonic (usually oxytocin), controlled cord traction, and uterine massage to reduce postpartum hemorrhage.

A short BRAIN-style set you can bring to any conversation about interventions, monitoring, or care decisions.

• ?Why are you recommending this now — is it urgent, routine, or optional?
• ?What happens if we wait an hour (or longer) before deciding?
• ?What signs would tell us this is working — or that we need to change course?
• ?What are the alternatives, including doing nothing?
• ?What would you recommend if this were your family?
• ?What would change your recommendation?

Tap a source to open the original guideline or review in a new tab.

• ·ACOG Practice Bulletin 183: Postpartum Hemorrhage↗ — ACOG
• ·WHO recommendations on prevention and treatment of postpartum haemorrhage↗ — WHO

Plain-language paraphrase. Re-verify before publish.

Last reviewed: 2026-07-03

• v1.0.0 · 2026-07-03 · LlaMamma editors

  Initial retained placenta topic.

New guidance from ACOG, WHO, Evidence Based Birth, or other listed sources is recorded here and can be updated remotely without a new app release.