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Comparative Study
. 2014 Jan 21:14:37.
doi: 10.1186/1471-2393-14-37.

Umbilical vein injection of misoprostol versus normal saline for the treatment of retained placenta: intrapartum placebo-controlled trial

Sheelan S Rajab, Shahla K Alalaf  1
Affiliations
Comparative Study

Umbilical vein injection of misoprostol versus normal saline for the treatment of retained placenta: intrapartum placebo-controlled trial

Sheelan S Rajab et al. BMC Pregnancy Childbirth. .

Abstract

Background: The third stage of labour may be complicated by retained placenta, which should be managed promptly because it may cause severe bleeding and infection, with a potentially fatal outcome. This study evaluated the effectiveness of umbilical vein injection of misoprostol for the treatment of retained placenta in a hospital setting.

Methods: This hospital-based placebo-controlled trial was conducted at the Maternity Teaching Hospital, Erbil City, Kurdistan region, Northern Iraq from April 2011 to February 2012. The inclusion criteria were: gestational age of at least 28 weeks, vaginal delivery, and failure of the placenta to separate within 30 minutes after delivery of the infant despite active management of the third stage of labour. Forty-six women with retained placentas were eligible for inclusion. After informed consent was obtained, the women were alternately allocated to receive umbilical vein injection of either 800 mcg misoprostol dissolved in 20 mL of normal saline (misoprostol group) or 20 mL of normal saline only (saline group). The women were blinded to the group allocation, but the investigator who administered the injection was not. The trial was registered by the Research Ethics Committee of Hawler Medical University.

Results: After umbilical vein injection, delivery of the placenta occurred in 91.3% of women in the misoprostol group and 69.5% of women in the saline group, which was not a significant difference between the two groups. The median vaginal blood loss from the time of injection until delivery of the placenta was significantly less in the misoprostol group (100 mL) than in the saline group (210 mL) (p value < 0.001).

Conclusion: Umbilical vein injection of misoprostol is an effective treatment for retained placenta, and reduces the volume of vaginal blood loss with few adverse effects.

Clinical trial registration: Current Controlled Trial HMU: N252.1.2011.

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Figures

Figure 1
Figure 1
Flowchart for trial entry. Abbreviations: AMTSL active management of the third stage of labour, RP retained placenta, MROP manual removal of placenta, UVI umbilical vein injection.
See this image and copyright information in PMC

References

    1. Hidar S, Jennane TM, Bouguizane S, Lassoued L, Bibi M, Khairi H. The effect of placental removal method at cesarean delivery on perioperative hemorrhage: a randomized clinical trial ISRCTN 49779257. Eur J Obstet Gynecol Reprod Biol. 2004;117:179–182. doi: 10.1016/j.ejogrb.2004.03.014. - DOI - PubMed
    1. National Collaborating Centre for Women’s and Children’s Health (NCCWCH) Intrapartum Care. Care of healthy women and their babies during childbirth. London: RCOG Press; 2007. - PubMed
    1. Ely JW, Rijhsinghani A, Bowdler NC, Dawson JD. The association between manual removal of placenta and postpartum endometritis following vaginal delivery. Obstet Gynecol. 1995;86:1002–1006. doi: 10.1016/0029-7844(95)00327-N. - DOI - PubMed
    1. Deyer TW, Ashton-Miller JA, Van Baren PM, Pearlman MD. Myometrial contractile strain at uteroplacental separation during parturition. Am J Obstet Gynecol. 2000;183:156–159. - PubMed
    1. Carroli G, Belizan JM, Grant A, Gonzalez L, Campodonico L, Bergel E. Intraumbilical vein injection and retained placenta: evidence from a collaborative large randomized controlled trial. Br J Obstet Gynaecol. 1998;105:179–185. doi: 10.1111/j.1471-0528.1998.tb10049.x. - DOI - PubMed

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