If there is retained placenta after delivery (even if very premature) the risks of infection and hemorrhage are very significant and in the past, curettage (D&C) was basically the only option. Prior to any therapy, it is important to verify that retained placental fragments ARE present via ultrasound. If the ultrasound is indicative of retained products, a number of different medications may achieve complete expulsion, eliminating the need for surgery. The alternative to medical treatment should be discussed with your doctor who may refer you to another physician who is more familiar with their use. If curettage is necessary, it should be done under ultrasound guidance because ultrasound guidance would reduce the risk of excessive uterine damage and the risk of leaving some tissue within the uterus, perhaps necessitating another curettage. If there is infection, the patient will become quite sick and any curettage done at that time (which would be necessary) would increase the risk of uterine injury, and of spreading the infection. Without infection, the retained tissue may become calcified and removal would be difficult and increase the risk of scar formation.

If the patient has had a D & C and this was done between the 2nd & 4th weeks after delivery, she has a very high risk of developing Asherman's Syndrome, a risk which is probably increased if she is breast feeding (due to low estrogen) and which may be diminished if some steps are taken soon.

If retained placenta is suspected, IT IS NECESSARY TO HAVE AN ULTRASOUND AS SOON AS POSSIBLE. If there is a significant amount of retained placental tissue (the finding of a "complete and intact" placenta at the time of delivery is not 100% accurate), this is an accident waiting to happen!

Report to your doctor if you have any of the symptoms below for Retained Placenta. (Does not necessarily have to be all of these)

• Smelly discharge
• Liver like chunks coming out
• Fever
• Heavy bleeding for more than 10 days