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The 4-vessel Sampling Approach to Integrative Studies of Human Placental Physiology In Vivo
Published on: August 2, 2017
Pharmacologic intervention for retained placenta: a systematic review and meta-analysis
James M N Duffy1, Sophie Mylan, Marian Showell
1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, the Women's Health Research Unit, The Blizard Institute, Barts and the London School of Medicine and Dentistry, London, and the School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom; and the Cochrane Menstrual Disorders and Subfertility Group, University of Auckland, Auckland, New Zealand.
No pharmacologic treatments effectively manage retained placenta once diagnosed. Manual removal is recommended as the primary intervention for this condition.
Area of Science:
- Obstetrics and Gynecology
- Pharmacology
- Reproductive Medicine
Background:
- Retained placenta occurs when the placenta is not delivered within 30 minutes of active management of the third stage of labor.
- Effective pharmacologic interventions for retained placenta are not well-established.
Purpose of the Study:
- To evaluate the efficacy and safety of pharmacological treatments for retained placenta.
- To compare various drug interventions against placebo for managing retained placenta.
Main Methods:
- Systematic review and meta-analysis of 16 randomized controlled trials (RCTs) involving 1,683 participants.
- Searched multiple databases including Cochrane CENTRAL, EMBASE, and MEDLINE up to June 2014.
- Included RCTs comparing pharmacologic interventions with placebo for retained placenta treatment.
Main Results:
- No statistically significant differences were found in the need for manual placental removal between pharmacologic treatments (oxytocin, prostaglandins, nitroglycerin) and placebo.
- Limited reporting of secondary outcomes across the included studies.
- Specific comparisons included oxytocin (RR 0.86), prostaglandins (RR 0.82), nitroglycerin (RR 1.06), and combined oxytocin/nitroglycerin (RR 0.23) versus placebo.
Conclusions:
- Once retained placenta is diagnosed, no pharmacologic treatment has demonstrated effectiveness.
- Immediate manual removal of the placenta should be considered upon diagnosis.
- Oxytocin is effective in diminishing third-stage bleeding but not for treating established retained placenta.
