What is the optimal pharmacological management of retained placenta?

Duffy, James M N; Wilson, Matthew; Khan, Khalid S.

doi:10.1136/bmj.g4778

Cited by 2 publications

(4 citation statements)

References 9 publications

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“…Various clinical trials, systematic reviews, and metaanalysis of trials comparing IUV oxytocin (with or without © 2019 IJNR | Published by Innovational Publishers Figure 6: Need for manual removal of the placenta need for manual removal of the placenta, and spontaneous expulsion of the placenta. [1,9,16,17] In this meta-analysis, we included nine trials to compare IUV injection route with conventional IM and IV routes for administration of oxytocic agents. Of which, four trials compared IUV versus IV oxytocin, [6,[12][13][14] two trials compared IUV oxytocin with © 2019 IJNR | Published by Innovational Publishers IV carbetocin, [5,11] and three trials compared IUV versus IM oxytocin.…”

Section: Discussionmentioning

confidence: 99%

“…A period between birth of fetus and delivery of the placenta along with membranes is known as third-stage of labor. [1][2][3] Many times third stage may cause serious complication for both mother and newborn. [4,5] If duration of the third stage exceeds 30 min, it may result in serious risk of postpartum hemorrhage, puerperal infection, and retained placenta.…”

Section: Introductionmentioning

confidence: 99%

“…As per the recommendation of NICE guidelines, oxytocin infusion can be given through the umbilical vessels to increase myometrial contraction. [1] However, after the development of this guideline, various randomized controlled trials (RCTs) and reviews reported no significant differences in results of intraumbilical oxytocin and placebo in rates of manual removal of the placenta and other outcomes such as postpartum hemorrhage and infection rate. [9,10] Even the IV infusion of oxytocin is the most common practice and has not been evaluated in reviews and not compared with IUV oxytocic agents.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Intra Umbilical Vein (IUV) Injection of Oxytocic Agents on Outcome of the Third Stage of Labor: A Meta-analysis

Bishnoi¹,

Devi²,

Desai³

2019

IJNR

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Background: Active management of the third stage of labor can easily prevent life-threatening complications of the third stage such as retention of the placenta or its parts, prolonged duration, or postpartum hemorrhage due to atonicity of the uterus. Intraumbilical vein (IUV) injection of oxytocic agents is recommended by some guidelines. Unfortunately, intravenous (IV) oxytocin, although common practice, has not been compared with IUV oxytocic agents in reviews and meta-analysis. Therefore, the main objective of this meta-analysis was to compare the effects of IUV oxytocic agents with intramuscular (IM) and Intravenous (IV) oxytocics on outcomes of the third stage. Materials and Methods: The authors searched randomized and non-randomized control trials through electronic databases which include PubMed, Cochrane Library, and CINAHL and gray literature. The search terms were "umbilical vein injection," "intraumbilical vein injection," "umbilical vein oxytocin," oxytocin, uterotonic, placenta, "retained placenta," labor, "third stage of labor," and "postpartum hemorrhage." Five hundred and ninety-four articles were identified and nine met the inclusion criteria. Data were analyzed by Review Manager 5.3. Results: The pooled results reported that duration of the third stage was 1.23 minutes (95% confidence interval [CI]: 0.41-2.04) shorter, amount of blood loss was 79.09 ml. (95% CI: 46.90-111.28) lesser, and placental separation time was 37.69 seconds (95% CI: 0.58-74.80) shorter in the IUV oxytocin group than the IV oxytocin group. Comparison of IUV oxytocin and IV carbetocin shows no statistically significant differences. In comparison with IM oxytocin, IUV oxytocin also results in 1.13 min (95% CI: 0.28-1.97) shorter duration of the third stage of labor but not shows any significant difference for amount of blood loss. Conclusion: IUV oxytocin is more beneficial for reduction of duration of the third stage of labor, amount of blood loss, and placental separation time than the IV and IM oxytocin.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of Intra Umbilical Vein (IUV) Injection of Oxytocic Agents on Outcome of the Third Stage of Labor: A Meta-analysis

Bishnoi¹,

Devi²,

Desai³

2019

IJNR

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“…It can happen in up to 3.3% of births around the world, depending on the area [2][3][4][5][6][7][8][9]. The incidence of retained placenta is expected to rise due to increasing maternal age and risk factors such as previous cesarean delivery [10,11]. It is the second leading cause of postpartum bleeding and can result in a mortality rate of up to 10% without prompt treatment [3,[11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Racial and ethnic disparities in the incidence, healthcare utilization, and outcomes of retained placenta among delivery hospitalizations in the United States, 2016–2019

Jiang,

Chen,

2023

BMC Pregnancy Childbirth

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Background Retained placenta is a concern during labor and delivery. However, recent data regarding the profiles of retained placenta are scarce, especially nationwide and in minority populations. This study aimed to investigate the recent incidence of retained placenta and its associated outcomes. Methods We retrospectively analyzed an American population-based data from the National Inpatient Sample (NIS) 2016–2019. The outcomes of interest included the incidence of retained placenta, in-hospital mortality, length of hospital stay, and hospitalization costs. We estimated the incidence for retained placenta overall and by racial and ethnic subgroups, utilizing survey weights standardized for each subgroup. Multivariable linear or logistic regression models were employed in our study to investigate the associations between retained placenta and the impact of in-hospital mortality, duration of stay, and hospitalization expenditures for the entire population and further stratified by race and ethnicity, adjusting for potential confounders. Results Of the 13,848,131 deliveries, there were 108,035 (or 0.78%) birthing persons were identified as having retained placentas. Over time, the incidence of retained placenta increased from 730 per 100,000 (0.73%) in 2016 to 856 per 100,000 (0.86%) in 2019. Native American mothers have the highest rate of retained placenta, with a prevalence almost twice that of the general population, reaching 1,434 cases per 100,000 (1.43%). After adjusting for confounding factors, Native American mothers were more likely to have retained placenta (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.35–1.81), whereas Black (OR, 0.92; 95% CI, 0.88–0.97) and Hispanic mothers (OR, 0.84; 95% CI, 0.80–0.89) were significantly less likely to have retained placenta than White mothers. Furthermore, those who delivered with a retained placenta were significantly associated with higher in-hospital mortality, a longer duration of stay, and hospitalization expenditures, which were disproportionately varied by maternal race and ethnicity. Conclusions The incidence of retained placenta among people undergoing vaginal delivery is exhibiting an upward trend over time, with notable variations observed across different ethnic groups by unclear mechanisms. The ramifications of these findings have the potential to impact the clinical management of maternal health care and the creation of health policies, specifically in relation to the Native American birth population.

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What is the optimal pharmacological management of retained placenta?

Cited by 2 publications

References 9 publications

Effect of Intra Umbilical Vein (IUV) Injection of Oxytocic Agents on Outcome of the Third Stage of Labor: A Meta-analysis

Effect of Intra Umbilical Vein (IUV) Injection of Oxytocic Agents on Outcome of the Third Stage of Labor: A Meta-analysis

Racial and ethnic disparities in the incidence, healthcare utilization, and outcomes of retained placenta among delivery hospitalizations in the United States, 2016–2019

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