The Rule of Ultrasonography in the Management of Retained Placenta

Retained placenta is clinically diagnosed when the placenta has failed to deliver within 18 to 60 minutes after birth. The retained placenta is a risk factor for postpartum fever. In this paper, we report a patient with a delivery complicated by a retained placenta and postpartum fever. This patient, a 34-year-old pregnant female, was admitted at 32 weeks of gestation for a case of preterm labor with preterm premature rupture of membranes and bacterial vaginosis. A 2.5 kg infant was delivered by normal vaginal delivery, which was followed by active management of the third stage of labor. The retained placenta was removed manually under general anesthesia. Two days later, the patient developed a fever and elevated inflammatory markers. Ultrasound-guided evacuation and curettage were done, and two endometrial cavities were noted. Both cavities were evacuated of products of conception. Two days later, the patient started to have spikes of fever. Imaging revealed an intra-cavity soft tissue mass measuring 6.5 cm. Hysteroscopy with dilation and curettage was performed and showed fibrous bands covering a soft mass of products of conception, which was then evacuated.