Umbilical Vein Oxytocin for the Treatment of Retained Placenta (Release Study): A Double-Blind, Randomized Controlled Trial

Abstract

The little data that exist on reasons for postpartum readmission after initial hospitalization for delivery have focused primarily on route of delivery rather than specific indications that necessitate readmission. The aim of this study was to investigate indications for postpartum readmission. The study participants were women who delivered during 2007 and were readmitted within 6 weeks of the original delivery discharge date at 114 Hospital Corporation of America hospitals in 21 states. Preliminary data suggested an especially higher rate of readmission than could be expected for pneumonia, cholecystitis, and acute appendicitis. To address this issue, a stratified analysis was conducted for hospital readmission rates among women with these indications who were readmitted within 180 days after their delivery. Curve comparisons were made using linear regression analysis, survival curve fitting, and Gehan-Breslow statistic with Holm-Sidak all pairwise analysis for multiple comparisons.Of the 222,751 women who delivered in 2007, 2655 women (1.2%) were readmitted within 6 weeks. There was a more than 2-fold increase in frequency of readmission for women who had cesarean section delivery compared to those who had vaginal birth (1.8% vs. 0.83%, P Ͻ 0.001). More than 80% of readmittances for pneumonia occurred within the first 6 weeks of delivery, as did more than 40% of readmittances for appendicitis or cholecystitis. Women readmitted during first 6 weeks after delivery had higher cumulative readmission rates for pneumonia, appendicitis, and cholecystitis compared to those who had been readmitted in the next 20 weeks (6 vs. 20 week comparison: pneumonia curve gradient, 3.7 vs. 0.11; appendicitis curve gradient, 1.1 vs. 0.36; cholecystitis curve gradient, 6.6 vs. 1.7).These findings show that the primary cause of postpartum readmission is infection and suggest that recent pregnancy may increase the risk of pneumonia, appendicitis, and cholecystitis. The investigators do not believe that any of these conditions has been causally linked previously to pregnancy or delivery. EDITORIAL COMMENT(Lydon-Rochelle, et al analyzed the risks for hospital readmission in a cohort of 256,795 women who delivered over a 10-year period in Washington state and found that, overall, 1.2% of women were rehospitalized in the 60 days following birth. The risk varied by mode of delivery: 1% after spontaneous vaginal birth, 1.2% after assisted vaginal birth, and 1.7% after cesarean delivery. Many of the diagnoses associated with the increased rate after cesarean were intuitive, and included higher rates of uterine and wound infection, postpartum hemorrhage, and thromboembolic disease. However, some were not, including an increased risk of admis-OBSTETRICS Volume 65, Number 5 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACTMaternal ovarian torsion is a very rare complication in pregnant women that may be misdiagnosed because signs and symptoms such as abdominal pain and nausea/vomiting are nonspecific and are present in a number of obstetric and sur...

Carbetocin versus intra‐umbilical oxytocin in the management of retained placenta: A randomized clinical study

“…The tube was then withdrawn by 5 cm to allow for any divisions of the vein prior to its insertion into the placenta. This method resulted in complete filling of the placental bed capillaries …”

“…This method resulted in complete filling of the placental bed capillaries. 12 At 30 and 45 min after administration of the medication, or in the case of clinical signs of placental separation, an attempt to deliver the placenta was made. If the final attempt to deliver the placenta (45 min after administration of the study medication) failed, manual removal was performed in the operation theatre.…”

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

“…These guidelines recommend injecting saline-diluted oxytocin into the umbilical vein. However a large, randomized, controlled trial recently reported that the injection had no clinically significant effect on the need to remove retained placenta manually [5].…”