{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T09:12:49Z","timestamp":1783933969767,"version":"3.55.0"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T00:00:00Z","timestamp":1745798400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Retained placenta (RP) is the absence of placental expulsion within 30\u202fmin of neonatal delivery. It is an obstetric complication affecting 0.5\u20134.8% of all vaginal deliveries. We report two cases in which the patients were primiparous. Patients were initially kept at the hospital under close observation. The lack of spontaneous detachment and the absence of bleeding prompted us to resort to an expectant approach approved by both patients. A decrease in B-hCG levels was followed by a steady decrease in placental size and the resumption of regular menses. The management of RP should be individualized according to hospital resources, patient fertility desire, sonographic characteristics, the presence of hemorrhage, and hemodynamic stability. RP should prompt the mobilization of resources needed for managing postpartum hemorrhage (PPH), which might ensue without notice. Manual removal of the placenta (MROP) has been recommended for managing RP regardless of hemorrhage or retention etiology. MROP, however, might initiate massive bleeding, infections, prolonged hospitalization, the need for curettage and hysterectomy. Moreover, if MROP is attempted in an unidentified placenta accreta spectrum (PAS), it might initiate life-threatening hemorrhage, necessitating the performance of hemostatic interventions, including emergent hysterectomy. Serious considerations should be given to mitigate the indiscriminate use of MROP in the era of the \u201cPAS epidemic.\u201d<\/jats:p>","DOI":"10.3389\/fmed.2025.1504491","type":"journal-article","created":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T04:11:40Z","timestamp":1745813500000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Retained non-previa placenta in the era of \u201cplacenta accreta spectrum\u201d: a report of two cases managed expectantly and a proposed plan for management"],"prefix":"10.3389","volume":"12","author":[{"given":"Mohamad K.","family":"Ramadan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nouhad","family":"El-Zein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murchida","family":"Jomaa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abir","family":"Zeidan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rana","family":"El Tal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominique A.","family":"Badr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,4,28]]},"reference":[{"key":"ref1","year":""},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12884-021-03721-9","article-title":"Risk factors for non-adherent retained placenta after vaginal delivery: a systematic review","volume":"21","author":"Favilli","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1016\/0002-9378(90)91076-O","article-title":"Preterm delivery: a risk factor for retained placenta","volume":"163","author":"Romero","year":"1990","journal-title":"Am J Obstet Gynecol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"527","DOI":"10.2147\/IJWH.S218933","article-title":"Retained placenta after vaginal delivery: risk factors and management","volume":"11","author":"Perlman","year":"2019","journal-title":"Int J Women's Health"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"903","DOI":"10.1007\/s00404-021-06027-5","article-title":"Retained placenta and postpartum hemorrhage: time is not everything","volume":"304","author":"Franke","year":"2021","journal-title":"Arch Gynecol Obstet"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1097\/GRF.0000000000000391","article-title":"The placenta accreta spectrum: epidemiology and risk factors","volume":"61","author":"Carusi","year":"2018","journal-title":"Clin Obstet Gynecol"},{"key":"ref7","volume-title":"Pregnancy, childbirth, postpartum and newborn care: a guide for essential practice","year":"2015"},{"key":"ref8","first-page":"502","article-title":"Retained placental tissue as an emerging cause for malpractice claims","volume":"16","author":"Fejgin","year":"2014","journal-title":"Isr Med Assoc J"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2014\/274651","article-title":"Manual removal of the placenta after vaginal delivery: an unsolved problem in obstetrics","volume":"2014","author":"Urner","year":"2014","journal-title":"J Pregnancy"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1111\/j.1479-828X.2001.tb01292.x","article-title":"Manual removal of the placenta-a case-control study","volume":"41","author":"Titiz","year":"2001","journal-title":"Aust N Z J Obstet Gynaecol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"3867","DOI":"10.1111\/jog.15004","article-title":"Manual removal of the placenta and postpartum hemorrhage: a multicenter retrospective study","volume":"47","author":"Fujita","year":"2021","journal-title":"J Obstet Gynaecol Res"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"783","DOI":"10.1097\/GRF.0000000000000395","article-title":"Conservative management of placenta accreta spectrum","volume":"61","author":"Sentilhes","year":"2018","journal-title":"Clin Obstet Gynecol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1016\/j.placenta.2020.04.005","article-title":"Uterine body placenta accreta spectrum: a detailed literature review","volume":"95","author":"Badr","year":"2020","journal-title":"Placenta"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"101027","DOI":"10.1016\/j.ajogmf.2023.101027","article-title":"Pathologically diagnosed placenta accreta spectrum without placenta previa: a systematic review and meta-analysis","volume":"5","author":"Sugai","year":"2023","journal-title":"Am J Obstet Gynecol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1097\/01.AOG.0000151993.83276.70","article-title":"The length of the third stage of labor and the risk of postpartum hemorrhage","volume":"105","author":"Magann","year":"2005","journal-title":"Obstet Gynecol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"CD000007","DOI":"10.1002\/14651858.CD000007","article-title":"Active versus expectant management in the third stage of labour","volume":"2009","author":"Prendiville","year":"2000","journal-title":"Cochrane Database Syst Rev"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.placenta.2022.05.004","article-title":"Retained products of conception (RPOC) following delivery without placenta previa: which patients with RPOC show postpartum hemorrhage?","volume":"124","author":"Takahashi","year":"2022","journal-title":"Placenta"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1007\/s00404-017-4579-2","article-title":"Failed manual removal of the placenta after vaginal delivery","volume":"297","author":"Bjurstr\u00f6m","year":"2018","journal-title":"Arch Gynecol Obstet"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1016\/S0002-9378(11)91557-9","article-title":"Postpartum ultrasonographic findings associated with placenta accreta","volume":"167","author":"Shapiro","year":"1992","journal-title":"Am J Obstet Gynecol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1002\/jcu.1870220312","article-title":"Placenta accreta: postpartum diagnosis and a potentially new mode of management using real-time ultrasonography","volume":"22","author":"Petrovic","year":"1994","journal-title":"J Clin Ultrasound"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1046\/j.1469-0705.1996.07010058.x","article-title":"Sonographic diagnosis of a non-previa placenta accreta","volume":"7","author":"Jauniaux","year":"1996","journal-title":"Ultrasound Obstet Gynecol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1046\/j.1469-0705.2000.00057.x","article-title":"Complicated third stage of labor: time to switch on the scanner","volume":"15","author":"Herman","year":"2000","journal-title":"Ultrasound Obstet Gynecol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1111\/j.1600-0412.2012.01494.x","article-title":"Postpartum monitoring of retained placenta. Two cases of abnormally adherent placenta","volume":"92","author":"Torrenga","year":"2013","journal-title":"Acta Obstet Gynecol Scand"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1016\/j.ajog.2019.01.233","article-title":"Prevalence, and main outcomes of placenta accreta spectrum: a systematic review and meta-analysis","volume":"221","author":"Jauniaux","year":"2019","journal-title":"Am J Obstet Gynecol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1097\/AOG.0000000000000962","article-title":"Three-dimensional power Doppler ultrasonography for diagnosing abnormally invasive placenta and quantifying the risk","volume":"126","author":"Collins","year":"2015","journal-title":"Obstet Gynecol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1111\/aogs.12065","article-title":"No reduction of manual removal after misoprostol for retained placenta: a double-blind, randomized trial","volume":"92","author":"Van Stralen","year":"2013","journal-title":"Acta Obstet Gynecol Scand"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"148","DOI":"10.12816\/0060174","article-title":"Guidelines for intraoperative management of unexpected \u201cplacenta Accreta Spectrum\u201d","volume":"68","author":"Ramadan","year":"2020","journal-title":"Lebanese Med J"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"e11832","DOI":"10.7759\/cureus.11832","article-title":"Conservative management of placenta accreta using helium plasma focused radiofrequency energy: a surgical technique","volume":"12","author":"Nguyen","year":"2020","journal-title":"Cureus"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"S2","DOI":"10.1055\/s-0040-1722240","article-title":"Expectant management of placenta accreta spectrum disorders","volume":"7","author":"Kondoh","year":"2021","journal-title":"Surg J"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1097\/FM9.0000000000000077","article-title":"Placenta accreta spectrum: conservative management and its impact on future fertility","volume":"3","author":"Abbas","year":"2021","journal-title":"Matern Fetal Med"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"678","DOI":"10.3390\/medicina58050678","article-title":"Risk of subsequent hysterectomy after expectant management in the treatment of placenta accreta spectrum disorders","volume":"58","author":"Panaitescu","year":"2022","journal-title":"Medicina"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3109\/01443615.2010.532248","article-title":"Management of placenta previa and accreta","volume":"31","author":"Allahdin","year":"2011","journal-title":"J Obstet Gynaecol"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"S3","DOI":"10.1016\/j.ajog.2019.11.020","article-title":"4: conservative management versus cesarean hysterectomy for placenta accreta spectrum; the PACCRETA prospective population-based study","volume":"222","author":"Sentilhes","year":"2020","journal-title":"Am J Obstet Gynecol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"992215","DOI":"10.3389\/fmed.2022.992215","article-title":"Long-term gynecological complications after conservative treatment of placenta accreta spectrum","volume":"9","author":"Herzberg","year":"2022","journal-title":"Front Med"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"243.e1","DOI":"10.1016\/j.ajog.2021.08.026","article-title":"Failure of placental detachment in accreta placentation is associated with excessive fibrinoid deposition at the utero-placental interface","volume":"226","author":"Jauniaux","year":"2022","journal-title":"Am J Obstet Gynecol"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"168","DOI":"10.3390\/healthcare11020168","article-title":"Conservative management for retained products of conception in late pregnancy","volume":"11","author":"Fujishima","year":"2023","journal-title":"Healthcare (Basel)"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1002\/ijgo.12397","article-title":"Perinatal research network Group in Japan. Retrospective multicenter study of leaving the placenta in situ for patients with placenta previa on a cesarean scar","volume":"140","author":"Miyakoshi","year":"2018","journal-title":"Int J Gynecol Obstet"},{"key":"ref38","first-page":"69","article-title":"Factors associated with postpartum hemorrhage with vaginal birth","volume":"77","author":"Combs","year":"1991","journal-title":"Obstet Gynecol"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1279","DOI":"10.1016\/0002-9378(95)91493-5","article-title":"Third stage of labor: analysis of duration and clinical practice","volume":"172","author":"Dombrowski","year":"1995","journal-title":"Am J Obstet Gynecol"},{"key":"ref40","volume-title":"WHO recommendations for the prevention and treatment of postpartum hemorrhage","year":"2012"},{"key":"ref41","first-page":"9","article-title":"<Original> conservative treatment of retained placenta in six patients: a retrospective case series analysis of conservative medical treatment against retained placenta was possible in six cases","volume":"44","author":"Fujishima","year":"2019","journal-title":"Acta Med Kindai Univ"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.ejogrb.2019.06.016","article-title":"Conservative management of retained products of conception in the normal placental position: a retrospective observational study","volume":"240","author":"Takahashi","year":"2019","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"2063","DOI":"10.1080\/14767058.2020.1777272","article-title":"The role of ultrasound imaging in the management of partial placental retention after third-trimester livebirth","volume":"35","author":"Jauniaux","year":"2022","journal-title":"J Matern Fetal Neonatal Med"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1002\/uog.27547","article-title":"Placenta accreta spectrum conservative management and coagulopathy: case series and systematic review","volume":"63","author":"Abi Habib","year":"2024","journal-title":"Ultrasound Obstet Gynecol"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1097\/AOG.0b013e3181d066d4","article-title":"Maternal outcome after conservative treatment of placenta accreta","volume":"115","author":"Sentilhes","year":"2010","journal-title":"Obstet Gynecol"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"910","DOI":"10.1016\/j.jmig.2014.04.004","article-title":"Conservative management of placenta accreta: hysteroscopic resection of retained tissues","volume":"21","author":"Legendre","year":"2014","journal-title":"J Minim Invasive Gynecol"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1016\/j.ijgo.2014.05.013","article-title":"Outcomes of subsequent pregnancies after conservative treatment for placenta accreta","volume":"127","author":"Kabiri","year":"2014","journal-title":"Int J Gynecol Obstet"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1002\/ijgo.12761","article-title":"FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders","volume":"146","author":"Jauniaux","year":"2019","journal-title":"Int J Gynaecol Obstet"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1504491\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T04:11:42Z","timestamp":1745813502000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1504491\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,28]]},"references-count":48,"alternative-id":["10.3389\/fmed.2025.1504491"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1504491","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,28]]},"article-number":"1504491"}}