Irregularly shaped, (moth-eaten) placental lacunae.Postpartum hemorrhage at the time of attempted manual separation of the placenta.Placenta previa generally manifests with placenta accreta.History of uterine surgery (e.g., curettage).Surgical (when manual extraction fails).Active management of the third stage of labor.General measures (e.g., monitor vital signs).Ultrasound: shows a focal endometrial mass.Postpartum manual palpation and speculum inspection of the placenta and fetal membranes.Inability to completely separate the placenta during the third stage of labor.Severe bleeding before placental delivery.Prior history of retained placenta (most common).General measures (e.g., monitor vital signs, fluid therapy) and immediate manual uterine reposition.Ultrasound (confirms diagnosis in uncertain cases).Absent fundus (top of the uterus) at the periumbilical position during transabdominal palpation.Round mass (inverted uterus) protruding from the cervix or vagina.Uncontrolled cord traction and/or excessive fundal pressure during the third stage of labor.Surgical procedures (uterine balloon tamponade or packing).Active management of the third stage of labor ( see “Prevention” below).Other (e.g., p reterm delivery, maternal BMI > 40 kg/m 2).
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