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Nitroglycerine for retained placenta: a meta-analysis of randomized controlled trials
Alessandro Petrecca1, Gabriele Saccone2, Vincenzo Berghella3
1Department of Women's, Child and Public Health Sciences, UOC Gynecology Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy (Dr Petrecca).
American Journal of Obstetrics & Gynecology MFM
|January 16, 2025
Summary
Nitroglycerine did not reduce manual removal rates for retained placenta after vaginal delivery. This systematic review found no significant differences in blood loss or need for uterotonics.
Area of Science:
- Obstetrics and Gynecology
- Pharmacology
- Evidence-Based Medicine
Background:
- Retained placenta after vaginal delivery is a common complication.
- Manual removal of the placenta is often required, carrying risks.
- Pharmacological interventions are explored to improve placental delivery.
Purpose of the Study:
- To evaluate the efficacy of nitroglycerine in facilitating placenta delivery.
- To determine if nitroglycerine reduces the need for manual removal of the placenta.
Main Methods:
- Systematic review and meta-analysis of randomized clinical trials.
- Searched multiple databases (MEDLINE, Scopus, Cochrane Library, etc.) until February 2024.
- Included four trials with 1,279 pregnancies comparing nitroglycerine to placebo/no treatment.
Main Results:
- Nitroglycerine administration showed a similar incidence of manual placenta removal compared to controls (89% vs 90%).
- No significant differences were observed in postpartum blood loss, hemoglobin drop, or need for uterotonics.
- The quality of the included randomized clinical trials was moderate.
Conclusions:
- Nitroglycerine is not effective in reducing the need for manual removal of the placenta.
- Current evidence suggests nitroglycerine does not offer a significant benefit for retained placenta management.
