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After Labor: Care for the Placenta

Q. My friend had to have the placenta extracted after delivery. Could this happen to me?

A. The so-called third stage of labor, when the placenta separates from the lining of the uterus and is "delivered," usually happens within 30 minutes of the baby's birth. In up to 3 percent of women, the placenta remains attached, a condition called "retained placenta." To prevent infection, the doctor needs to remove it either by manually loosening the mass or by surgically scraping the lining -- what's known as a dilation and curettage (a "D and C"). If it isn't completely removed, infection or hemorrhaging can follow days or even weeks afterward.

When the placenta does not deliver naturally, it's usually because the cord has sheared off during delivery or it has developed an abnormal adhesion to the uterine lining, says Megan Breen, M.D., assistant professor of obstetrics and gynecology at Georgetown University, in Washington, D.C. While any woman can have a retained placenta, women who have had surgeries such as a cesarean section or a fibroid removal are more at risk, says Fergal Malone, M.D., director of obstetric and gynecological ultrasound at Columbia University Medical Center, in New York City.

If this occurs, pain medication is available. An epidural given during labor can be continued, or if a woman didn't receive an epidural, says Dr. Malone, a narcotic, such as Demerol, or a spinal anesthetic can be administered. If the fully dilated cervix begins to close, however, a doctor may decide to begin the extraction immediately, without pain medication. The alternative is to let the cervix close and then do a D and C under light sedation. If you're concerned, you can discuss the options with your doctor before delivery.

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