Introduction : Retained placenta is a complication of the third stage of labor, in which all or part of the placenta remains within the uterine cavity and is not expelled. This condition can lead to postpartum hemorrhage, which may be life-threatening.

Observation : We report the case of a 31-year-old Rh-negative woman, G2P2 with a single-scar uterus, who presented with partial retained placenta in the late postpartum period, complicated by uterine atony. She was referred on postpartum day 28 due to spontaneous metrorrhagia. On examination, she was hemodynamically stable. Abdominal palpation was unremarkable, and speculum examination revealed minimal endometrial bleeding. Vaginal examination showed no palpable masses or uterine tenderness. Transabdominal ultrasound demonstrated an enlarged uterus with a thickened echogenic endometrium and a 4-cm heterogeneous, hyperechoic intrauterine mass; the adnexa were normal. Retained placenta was strongly suspected, and pelvic MRI confirmed retention of a cotyledon. Hysteroscopy revealed a partially detachable intrauterine mass. An ultrasound-guided aspiration was performed but complicated by moderate persistent bleeding despite medical management. Surgical intervention with bilateral triple ligation combined with B-Lynch uterine compression sutures was subsequently performed, resulting in favorable clinical outcome. Histopathological examination of the aspirated tissue confirmed retention of a cotyledon.

Conclusion : Even though this form of late retained placenta is rare, it highlights the importance of careful initial examination after delivery, during the third stage of labor, and thorough inspection of the placenta.

Gynecology 2026 Dr. Rania Chihaoui is a resident in Obstetrics and Gynecology at the Ministry of Public Health in Tunisia. She completed complementary certificates in Maternal Health. Her residency training includes rotations in Obstetrics and Gynecology at Ibn El Jazzar Hospital in Kairouan, Taher Sfar Hospital in Mahdia, and Kasserine Hospital. She has participated in national and international gynecology and obstetrics conferences, including AGOB and STGO.