Retained Placenta: Signs and When It's an Emergency

By trimester

Weeks 1–13

1st trimester

In the delivery room, providers watch for the placenta to deliver within about 30 minutes of your baby's birth. Most placentas actually deliver within about 18 minutes, and if it hasn't come by 30, manual extraction is the standard next step.

Weeks 14–27

2nd trimester

If small fragments were left behind without anyone noticing right away, symptoms can show up over the following days: heavier or increasing bleeding, passing clots or tissue, a fever, or foul-smelling discharge are the signals to call your provider the same day.

Weeks 28–birth

3rd trimester

Retained tissue can still cause what's called secondary postpartum hemorrhage up to about 12 weeks after birth, so ongoing heavy bleeding or infection signs shouldn't be written off as normal postpartum bleeding even several weeks out.

What does the evidence show for retained placenta?

• A retained placenta means the placenta hasn't delivered within 30 minutes of the baby's birth, though 95% of normal placental deliveries actually happen within about 18 minutes. 1
• Retained placenta happens in roughly 1% to 3% of vaginal deliveries, and someone with a prior retained placenta has about a 25% chance of it happening again in a later vaginal delivery. 2
• Warning signs of retained tissue after birth include sudden or increasingly heavy vaginal bleeding, passing clots or placental tissue, a strong or unpleasant odor to the bleeding or discharge, and fever, chills, or abdominal pain. 3
• Bleeding tied to retained placental tissue can show up as delayed, or secondary, postpartum hemorrhage, defined as heavy bleeding from more than 24 hours up to about 12 weeks after delivery, not just in the first day. 4
• Standard management is manual extraction under adequate pain control, with prophylactic antibiotics commonly given, though evidence specifically supporting the antibiotics is mixed. Hemorrhage that follows is managed with uterotonic medications and, in more serious cases, procedures up to hysterectomy. 2

When should I call my provider about retained placenta?

Sudden or increasingly heavy vaginal bleeding, passing clots or visible pieces of tissue, a strong or foul odor to your bleeding or discharge, and fever, chills, or abdominal pain are the specific signs of retained placental tissue that call for same-day medical attention, not a wait-and-see approach. These signs can show up right after birth or emerge days to weeks later as what's called secondary postpartum hemorrhage, which can occur anywhere from 24 hours to about 12 weeks postpartum. Heavy bleeding that soaks a pad in an hour, dizziness, a racing heart, or feeling like you might pass out are signs of significant blood loss and need emergency care right away. Trust your read on your own body. If something feels off beyond the list above, please consult your healthcare provider rather than waiting it out.