Management and outcomes of retained placenta at a provincial hospital in Papua New Guinea: a retrospective observational study

John Kukiti; Ian Umo; Alice Siwawata; Rodney Talo; Grace Kariwiga

doi:10.1071/MJ24010

RESEARCH ARTICLE (Open Access)

Next Contents Vol 66(1)

Management and outcomes of retained placenta at a provincial hospital in Papua New Guinea: a retrospective observational study

John Kukiti ^A , Ian Umo ^B ^* , Alice Siwawata ^A , Rodney Talo ^A and Grace Kariwiga ^A

+ Author Affiliations

- Author Affiliations

^A Obstetrics and Gynaecology Department, Alotau Provincial Hospital, Milne Bay Province, Papua New Guinea. Email: kukitijohn@gmail.com, assiwawata@gmail.com, talodrodney@gmail.com, gkariwiga6@gmail.com

^B Surgery Department, Alotau Provincial Hospital, Milne Bay Province, Papua New Guinea.

^* Correspondence to: sawavmvs@gmail.com

Handling Editor: Andrew Collins

Papua New Guinea Medical Journal 66, MJ24010 https://doi.org/10.1071/MJ24010

Submitted: 22 December 2024 Accepted: 8 May 2025 Published: 4 July 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of the Medical Society of Papua New Guinea. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Introduction

Retained placenta is a significant cause of postpartum haemorrhage and is a major contributor to maternal death. It is defined as the retention of the placenta 30 min after the delivery of a foetus. Milne Bay Province contributes to the high maternal mortality rate of Papua New Guinea. Between 2014 and 2022, 35% of maternal deaths at the Alotau Provincial Hospital were due to retained placenta. This study aims to describe the management and outcomes of mothers presenting with retained placenta to the Alotau Provincial Hospital.

Method

This was a retrospective study conducted over 8 years to investigate the management outcomes of retained placenta in a provincial hospital of Papua New Guinea.

Result

A total of 13,731 deliveries took place at the Alotau Provincial Hospital between 1 January 2014 and 31 December 2022. The incidence rate of retained placenta was 1.9%. Complete data were available for 180 of these cases, and they were analysed further. Active management of the third stage of labour was performed in 128 cases (71%). Manual removal of the placenta without anaesthesia in the hospital’s labour ward was successful in 51% of cases. The duration of the third stage ranged from 30 min to 16 days, with 45% (n = 82) of cases resolving within an hour. Postpartum haemorrhage occurred in 69% (n = 124) of cases, while 51% (n = 63) of patients experienced severe postpartum haemorrhage and hypovolemic shock. The sepsis rate was 20% (n = 36), and the maternal mortality rate was 0.6%.

Conclusion

This study highlights the substantial burden of retained placenta at the Alotau Provincial Hospital. Despite an increase in supervised deliveries, most emergency cases of retained placenta stem from unsupervised village births, often complicated by postpartum haemorrhage.

Keywords: Alotau Provincial Hospital, maternal mortality, Milne Bay Province, Papua New Guinea, postpartum haemorrhage, retained placenta, supervised delivery, unsupervised village birth.

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