Use of uterus relaxing drugs to deliver a retained placenta

Failure to deliver the placenta is an uncommon event that could be associated with significant morbidity and even death if left untreated. Conventional management involves introducing a hand inside the uterus under anaesthesia to manually remove the placenta, which carries some risks. The use of uterine relaxing drugs (tocolytics), either alone or with other drugs that stimulate contractions of the uterus, may bring on the delivery of the placenta and avoid the need for this invasive procedure. This review included one trial that randomised 24 women with the placenta remaining undelivered 40 minutes after delivery to a placebo or nitroglycerin tablets put under the tongue to facilitate delivery of the placenta. Both groups received oxytocin. Women who received nitroglycerin tablets were less likely to undergo surgical removal of the placenta and had less blood loss. Sublingual nitroglycerine caused minimal lowering of blood pressure and increased pulse rate. This result needs confirmation in larger trials with adequate sample sizes to verify the role of tocolytic drugs in managing different subtypes of retained placenta. (We have included explanation of some of the scientific terms in a glossary (Appendix 1).)