Intravenous nitroglycerin in the management of retained placenta

Thirty patients in the third stage of delivery complicated by retained placenta were prospectively managed with intravenous nitroglycerin. We studied the effect of nitroglycerin on the hemodynamics and characteristics of the procedure, and also analyzed labor and maternal and neonatal data. Intravenous nitroglycerin effectively aided the extraction of the retained placenta in all cases. The average procedure time was 5.3 +/- 1.1 min, and the dose range was 50-200 microg. Systolic and diastolic blood pressure fell significantly from 111 +/- 7.5 to 103 +/- 6 mm Hg and from 74 +/- 6.7 to 67 +/- 6.6 mm Hg, respectively (p<0.05). Although statistically significant, this was not evident clinically and there were no complications. Intravenous nitroglycerin at a dose of 200 microg or less is safe, effective and predictable in the management of retained placenta and could obviate the need of general anesthesia.