Mnemonic

4Ts of Postpartum Hemorrhage: Tone, Trauma, Tissue, Thrombin.

Abnormal placental separation (Tissue)

Retained placenta

Definition
- Retention of the placental tissue inside the uterine cavity following the first 30 min postpartum.
Risk factors
- Prior history of retained placenta (most common)
- Placenta previa
- Placenta accreta spectrum
Clinical features
- Main feature: severe bleeding before placental delivery
- Physical examination
  - Inability to completely separate the placenta during the third stage of labor
  - Speculum inspection: visualization of placental fragments or fetal membranes within the uterus

Active management of the third stage of labor: delivery of the placenta which involves the following components
- Uterotonic agents (IV/IM oxytocin)
- Controlled umbilical cord traction (Brandt-Andrews maneuver)
- External compression of the uterus and bimanual uterine massage