Systematic review of prostaglandin analogues for retained placenta

Abstract

Background: Medical management of retained placenta could be a safe alternative to manual removal.

Objective: To evaluate the efficacy of prostaglandin analogues for retained placenta.

Search strategy: MEDLINE, EMBASE, CENTRAL, ICTRP, LILACS, and OpenSIGLE were searched without language restrictions from inception to January 31, 2017, by combining terms for retained placenta and prostaglandin analogues.

Selection criteria: Randomized controlled trials comparing prostaglandin analogues with any other intervention.

Data collection and analysis: Trials were independently assessed for inclusion, data extraction, and risk of bias. Data were extracted for meta-analyses. GRADE was used to evaluate the quality of data.

Main results: Seven randomized controlled trials (851 patients) were included. Prostaglandins did not increase the placenta expulsion rate (relative risk [RR] 1.40, 95% confidence interval [CI] 0.83-2.36) or decrease maternal transfusion (RR 0.72, 95% CI 0.43-1.22). In comparison with oxytocin, prostaglandins did not modify the expulsion rate (RR 1.26, 95% CI 0.90-1.78), maternal transfusion (RR 1.05, 95% CI 0.27-4.09), or time for delivery of placenta (mean difference -1.56 minutes, 95% CI, -9.25-6.13). Three trials comparing prostaglandins with oxytocin agonists, ergometrine, and manual removal reported similar results.

Conclusions: Prostaglandin analogues do not offer an effective alternative for management of retained placenta.

Keywords: Ergonovine; Manual removal; Misoprostol; Oxytocin; Prostaglandins; Retained placenta; Systematic review.