What should be done if the placenta remains undelivered after 4 hours following a second-trimester loss?

When the placenta remains undelivered for more than 4 hours after a second-trimester loss, it is critical to intervene to prevent complications such as infection or hemorrhage. Surgical removal, typically through dilation and curettage (D&C), is the appropriate management in this scenario.

Given the time elapsed, the likelihood of spontaneous expulsion decreases, and the risks associated with retaining placental tissue increase. Surgical intervention not only ensures that all placental remnants are removed, thus reducing the risk of postpartum complications, but it can also provide a quicker resolution for the patient, allowing her to begin the healing process both physically and emotionally.

While administering more oxytocin or using misoprostol could be considered options in some cases to promote uterine contractions, their effectiveness may be diminished given the duration of retention, which can lead healthcare providers to favor surgical intervention instead. Waiting for natural expulsion is typically not advised in this scenario, as the prolonged retention of the placenta poses significant risks.