Umbilical vein injection for management of retained placenta

Nardin JM, Weeks A, Carroli G

Published Online:

May 11, 2011

The placenta provides nourishment for the baby in the womb (uterus) through the umbilical cord. It is usually delivered shortly after the baby. If the placenta remains in the womb (retained placenta), women have an increased risk of bleeding heavily (haemorrhage), infection and very occasionally death. Manual removal of the placenta involves an operation to remove the placenta, but it can have adverse effects.

The injection of oxytocin solution into the umbilical cord after the cord is cut is an inexpensive and simple intervention that could be performed while placental delivery is awaited. There was some evidence from the review of 15 trials, involving 1704 women, that an injection of oxytocin into the umbilical vein could reduce the need for manual removal of retained placenta after childbirth. However, high-quality randomized trials show that the use of oxytocin has little or no effect. Around half of the retained placentas will come out spontaneously if left; the optimal timing of manual removal is not known.

Abstract (click to read)

Background:

If a retained placenta is left untreated, there is a high risk of maternal death. However, manual removal of the placenta is an invasive procedure with serious complications of haemorrhage, infection or genital tract trauma.

Objectives:

To assess the use of umbilical vein injection (UVI) of saline solution alone or with oxytocin in comparison either with expectant management or with an alternative solution or other uterotonic agent for retained placenta.

Search strategy:

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 February 2011).

Selection criteria:

Randomized trials comparing UVI of saline or other fluids, with or without oxytocics, either with expectant management or with an alternative solution or other uterotonic agent, in the management of retained placenta.

Data collection and analysis:

Two review authors assessed the methodological quality of the studies and extracted the data.

Main results:

We included 15 trials (1704 women). The trials were of variable quality. Compared with expectant management, UVI of saline solution alone did not show any significant difference in the incidence of manual removal of the placenta (risk ratio (RR) 0.99; 95% confidence interval (CI) 0.84 to 1.16). UVI of oxytocin solution compared with expectant management showed no reduction in the need for manual removal (RR 0.87; 95% CI 0.74 to 1.03).

Oxytocin solution compared with saline solution alone showed a reduction in manual removal of the placenta, but this was not statistically significant (RR 0.91; 95% CI 0.82 to 1.00). When only high-quality studies were assessed, there was no statistical difference (RR 0.92; 95% CI 0.83 to 1.01). We detected no differences in any of the other outcomes.

UVI of oxytocin solution compared with UVI of plasma expander showed no statistically significant difference in the outcomes assessed by the only one small trial included. Prostaglandin solution compared with saline solution alone was associated with a statistically significant lower incidence in manual removal of placenta (RR 0.42; 95% CI 0.22 to 0.82) but we observed no difference in the other outcomes evaluated. Prostaglandin plus saline solution showed a statistically significant reduction in manual removal of placenta when compared with oxytocin plus saline solution (RR 0.43; 95% CI 0.25 to 0.75), and we also observed a small reduction in time from injection to placental delivery (mean difference -6.00; 95% CI -8.78 to -3.22). However, there were only two small trials contributing to this meta-analysis.

Authors' conclusions:

UVI of oxytocin solution is an inexpensive and simple intervention that could be performed while placental delivery is awaited. However, high-quality randomized trials show that the use of oxytocin has little or no effect. Further research into the optimal timing of manual removal and into UVI of prostaglandins or plasma expander is warranted.

This record should be cited as:

Nardin JM, Weeks A, Carroli G. Umbilical vein injection for management of retained placenta. Cochrane Database of Systematic Reviews 2011, Issue 5. Art. No.: CD001337. DOI: 10.1002/14651858.CD001337.pub2

Assessed as up to date:

March 10, 2011

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Primary Review Group:

Pregnancy and Childbirth Group

Health topics:

Pregnancy & childbirth > Post-partum haemorrhage/retained placenta

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Umbilical vein injection for management of retained placenta

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