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Archives of Gynecology and Obstetrics
Published in: Archives of Gynecology and Obstetrics 1/2014

01-01-2014 | Maternal-Fetal Medicine

Consecutive intra-umbilical vein injection of misoprostol and intravenous sulprostone in the management of retained placenta

Authors: Frouke Notten, Linda Meertens, Brechtje Wissink, Hubertina C. J. Scheepers

Published in: Archives of Gynecology and Obstetrics | Issue 1/2014

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Abstract

Introduction

Consecutive intra-umbilical vein injection of misoprostol and intravenous sulprostone in the management of retained placenta (RP).

Purpose

The general accepted treatment of RP is manual removal of the placenta (MRP), but medical intervention protocols were suggested. We evaluate a protocol of using intra-umbilical vein injection of misoprostol followed, if necessary, by intravenous sulprostone. A reduction in the need for MRP and less blood loss was expected.

Methods

Cohort A (1 January 2007 to 31 September 2008), managed by an expectative protocol including active management of the third stage of labor and if necessary MRP performed 60 min after birth of the baby, was compared with cohort B (1 April 2009 to 31 December 2010) managed by medical intervention protocol. This protocol consisted of intra-umbilical vein injection of misoprostol and if not successful, 250 μg of sulprostone was given intravenously in 30 min. All vaginal deliveries after 24 weeks of gestation, with RP after 20 min and blood loss <500 mL were included. An intention to treat analysis was performed, with the need for MRP as the primary outcome.

Results

Baseline characteristics were similar. In cohort A, 275 women met the inclusion criteria and 57 (20.7 %) women needed MRP. In cohort B, 219 women were included and 35 (16 %) women needed MRP. There was no significant difference in number of MRP, the amount of blood loss and other secondary outcomes.

Conclusions

We conclude that the use of intra-umbilical vein injection of misoprostol and intravenous sulprostone consecutively, does not reduce the number of MRPs as well as the total amount of blood loss in women with RP after 20 min. The study shows that changing obstetric management by extrapolating results from specific study groups to a general population may lead to other results.
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Metadata
Title
Consecutive intra-umbilical vein injection of misoprostol and intravenous sulprostone in the management of retained placenta
Authors
Frouke Notten
Linda Meertens
Brechtje Wissink
Hubertina C. J. Scheepers
Publication date
01-01-2014
Publisher
Springer Berlin Heidelberg
Published in
Archives of Gynecology and Obstetrics / Issue 1/2014
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-013-2919-4

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