Ramadan Mohamad K, El-Zein Nouhad, Jomaa Murchida, Zeidan Abir, El Tal Rana, Badr Dominique A
Division of Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, Makassed General Hospital, Beirut, Lebanon.
Department of Obstetrics and Gynecology, Makassed General Hospital, Beirut, Lebanon.
Front Med (Lausanne). 2025 Apr 28;12:1504491. doi: 10.3389/fmed.2025.1504491. eCollection 2025.
Retained placenta (RP) is the absence of placental expulsion within 30 min of neonatal delivery. It is an obstetric complication affecting 0.5-4.8% of all vaginal deliveries. We report two cases in which the patients were primiparous. Patients were initially kept at the hospital under close observation. The lack of spontaneous detachment and the absence of bleeding prompted us to resort to an expectant approach approved by both patients. A decrease in B-hCG levels was followed by a steady decrease in placental size and the resumption of regular menses. The management of RP should be individualized according to hospital resources, patient fertility desire, sonographic characteristics, the presence of hemorrhage, and hemodynamic stability. RP should prompt the mobilization of resources needed for managing postpartum hemorrhage (PPH), which might ensue without notice. Manual removal of the placenta (MROP) has been recommended for managing RP regardless of hemorrhage or retention etiology. MROP, however, might initiate massive bleeding, infections, prolonged hospitalization, the need for curettage and hysterectomy. Moreover, if MROP is attempted in an unidentified placenta accreta spectrum (PAS), it might initiate life-threatening hemorrhage, necessitating the performance of hemostatic interventions, including emergent hysterectomy. Serious considerations should be given to mitigate the indiscriminate use of MROP in the era of the "PAS epidemic."
胎盘滞留（RP）是指新生儿分娩后30分钟内胎盘未排出。它是一种产科并发症，影响所有阴道分娩的0.5-4.8%。我们报告两例初产妇病例。患者最初留在医院密切观察。由于缺乏自发剥离且无出血，我们采取了经患者双方认可的期待疗法。β-人绒毛膜促性腺激素（B-hCG）水平下降后，胎盘大小稳步减小，月经恢复正常。RP的管理应根据医院资源、患者生育意愿、超声特征、出血情况以及血流动力学稳定性进行个体化处理。RP应促使调动处理产后出血（PPH）所需的资源，PPH可能毫无征兆地发生。无论出血或滞留病因如何，均建议采用人工剥离胎盘（MROP）来处理RP。然而，MROP可能引发大量出血、感染、住院时间延长、需要刮宫和子宫切除术。此外，如果在未识别的胎盘植入谱系（PAS）中尝试MROP，可能引发危及生命的出血，需要进行包括紧急子宫切除术在内的止血干预。在“PAS流行”时代，应认真考虑减少MROP的滥用。
