Intravenous nitroglycerin for controlled cord traction in the management of retained placenta

Visalyaputra, Shusee; Prechapanich, Japarath; Suwanvichai, Sukanya; Yimyam, Suwimol; Permpolprasert, Ladda; Suksopee, Pattipa

doi:10.1016/j.ijgo.2010.08.021

Cited by 12 publications

(4 citation statements)

References 21 publications

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“…Much effort has been gone into finding alternative measures for management of retained placenta and associated PPH (Table ) but there are few randomized trials, with a small number of participants. Nitroglycerine orally, intravenously or intra‐umbilically, has been reported as either highly successful or ineffective . Intravenous sulprostone, described by Van Beekhuizen, reduced the number of manually removed placentas by 49% .…”

Section: Discussionmentioning

confidence: 99%

No reduction of manual removal after misoprostol for retained placenta: a double‐blind, randomized trial

Stralen¹,

Veenhof²,

Holleboom

et al. 2013

Acta Obstet Gynecol Scand

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Objective. To test the effect of 800 lg of misoprostol orally on the prevention of manual removal of retained placenta. Design. Multicenter, doubleblinded, placebo-controlled, randomized trial. Setting. One university and one non-university teaching hospital in the Netherlands. Sample. 99 women with retained placenta (longer than 60 min after childbirth) in the absence of postpartum hemorrhage. Methods. Eligible women were administered either 800 lg of misoprostol or placebo orally. Main outcome measures. Number of manual removals of retained placenta and amount of blood loss. Results. Manual removal of retained placenta was performed in 50% of the women who received misoprostol and in 55% who received placebo (relative risk 0.91, 95% confidence interval 0.62-1.34). No difference in the amount of blood loss (970 vs. 1120 mL; p = 0.34) was observed between the two groups. Conclusions. Administration of 800 lg of oral misoprostol, one hour after childbirth, does not seem to reduce the number of manual removals of retained placentas. The time elapsing results in the delivery of 50% of the retained placentas at the expense of an increased risk of postpartum hemorrhage.Abbreviations: PPH, postpartum hemorrhage.

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Section: Discussionmentioning

confidence: 99%

No reduction of manual removal after misoprostol for retained placenta: a double‐blind, randomized trial

Stralen¹,

Veenhof²,

Holleboom

et al. 2013

Acta Obstet Gynecol Scand

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“…However, this trial involved only 24 women and a subsequent larger study by the same team showed no significant benefit . Another small trial of intravenous nitroglycerin also demonstrated no benefit . We await with interest the outcome of the UK‐wide randomized controlled trial on the use of glycerin trinitrate for RP (GOT‐IT Trial).…”

Section: Conflicting Guidancementioning

confidence: 97%

Retained placenta: will medical treatment ever be possible?

Akol

Weeks

2016

Acta Obstet Gynecol Scand

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The standard treatment for retained placenta is manual removal whatever its subtype (adherens, trapped or partial accreta). Although medical treatment should reduce the risk of anesthetic and surgical complications, they have not been found to be effective. This may be due to the contrasting uterotonic needs of the different underlying pathologies. In placenta adherens, oxytocics have been used to contract the retro‐placental myometrium. However, if injected locally through the umbilical vein, they bypass the myometrium and perfuse directly into the venous system. Intravenous injection is an alternative but exacerbates a trapped placenta. Conversely, for trapped placentas, a relaxant could help by resolving cervical constriction, but would worsen the situation for placenta adherens. This confusion over medical treatment will continue unless we can find a way to diagnose the underlying pathology. This will allow us to stop treating the retained placenta as a single entity and to deliver targeted treatments.

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“…Literature Findings: Randomized controlled trials comparing IV or sublingual nitroglycerin with placebo for the purpose of uterine relaxation report inconsistent findings for the successful removal of retained placenta (Category A2-E evidence). [123][124][125] Observational studies and case reports indicate successful uterine relaxation and successful placental removal after IV or sublingual nitroglycerin administration (Category B3/B4 evidence). [126][127][128][129][130] Survey Findings: The ASA members agree and the consultants strongly agree that nitroglycerin may be used as an alternative to terbutaline sulfate or general endotracheal anesthesia with halogenated agents for uterine relaxation during removal of retained placental tissue.…”

Section: Nitroglycerin For Uterine Relaxationmentioning

confidence: 99%

Practice Guidelines for Obstetric Anesthesia

Apfelbaum¹,

Hawkins²,

Agarkar³

et al. 2016

Anesthesiology

468

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Intravenous nitroglycerin for controlled cord traction in the management of retained placenta

Abstract: Intravenously administered nitroglycerin did not facilitate the release of retained placenta by umbilical cord traction. However, cord traction may be performed longer than 30 minutes to attempt releasing the placenta before operative manual removal is initiated.

Cited by 12 publications

References 21 publications

No reduction of manual removal after misoprostol for retained placenta: a double‐blind, randomized trial

No reduction of manual removal after misoprostol for retained placenta: a double‐blind, randomized trial

Retained placenta: will medical treatment ever be possible?

Practice Guidelines for Obstetric Anesthesia

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