O73 Retained placenta and membranes, without hemorrhage

Name of the Condition

• Retained Placenta and Membranes, Without Hemorrhage (O73)

Summary

Retained placenta and membranes occur when all or part of the placenta or fetal membranes remain in the uterus after delivery, without associated bleeding. This condition requires monitoring and may necessitate intervention to prevent complications.

Causes

Retained placenta and membranes can result from factors that impede placental separation, such as uterine atony, placental adhesion, or incomplete expulsion during delivery. In some cases, it may be related to abnormal placental development or uterine scarring.

Risk Factors

• Prolonged labor or difficult delivery.
• Previous uterine surgery (e.g., cesarean section).
• Advanced maternal age.
• Multiparity (multiple pregnancies).
• Placenta previa or accreta in prior pregnancies.
• Use of uterine relaxants during labor.

Symptoms

• Delayed or absent placental expulsion after delivery.
• Uterine subinvolution (failure to contract to normal size).
• Mild abdominal discomfort or cramping.
• Prolonged lochia (vaginal discharge) without heavy bleeding.

Diagnosis

Diagnosis is typically made clinically by assessing the absence of placental expulsion within a reasonable time after delivery, often confirmed by ultrasound to detect retained tissue. Physical examination may reveal an enlarged or boggy uterus.

Treatment Options

• Expectant Management: Monitoring for spontaneous expulsion in asymptomatic cases.
• Manual Removal: Gentle manual extraction of retained tissue under anesthesia if needed.
• Medication: Oxytocin or other uterotonics to promote uterine contraction and expulsion.
• Surgical Intervention: Dilation and curettage (D&C) if retained tissue is not expelled or causes symptoms.

Prognosis and Follow-Up

With timely intervention, the prognosis is generally good. Follow-up may include monitoring for infection, uterine involution, and ensuring complete expulsion of tissue. Most cases resolve without long-term issues if managed appropriately.

Complications

• Uterine infection (endometritis).
• Postpartum hemorrhage (if hemorrhage develops).
• Delayed uterine involution.
• Rarely, sepsis or uterine perforation during removal.

Lifestyle & Prevention

• Prenatal care to address risk factors (e.g., managing placenta previa).
• Avoiding unnecessary uterine manipulations during labor.
• Prompt delivery management to reduce retention risk.

When to Seek Professional Help

Seek care if placental expulsion does not occur within a typical timeframe, or if symptoms like fever, heavy bleeding, or severe pain develop after delivery.

Tips for Medical Coders

Code O73 is used when retained placenta or membranes are present without hemorrhage. Documentation should specify the absence of bleeding and any interventions performed. Ensure clear differentiation from hemorrhage-related codes, as O73 excludes cases with active bleeding.