INTRAUMBILICAL OXYTOCIN FOR THE MANAGEMENT OF RETAINED PLACENTA - A RANDOMIZED CONTROLLED TRIAL

Objective: To evaluate the ability of intraumbilical oxytocin injectio n as a treatment for retained placenta after vaginal delivery to reduc e the incidence of manual removal and postpartum hemorrhage. Methods: A randomized controlled trial was set up in a university and a distric t general hospital. We recruited 81 women with singleton pregnancies w ho underwent vaginal delivery and who failed to deliver the placenta a fter 20 minutes of active management of the third stage of labor. Stud y subjects were randomized to receive either 1) an intraumbilical inje ction of oxytocin (20 IU in 20 mL of saline); 2) an intraumbilical inj ection of saline (20 mL); or 3) no treatment. Outcome measures were ex pulsion of the placenta within 45 minutes of delivery, need for manual removal of the placenta under anesthesia, and postpartum hemorrhage ( defined as a blood loss greater than 500 mL). Results: Women given an intraumbilical injection of oxytocin had a significant increase in spo ntaneous expulsion of the placenta within 45 minutes of delivery and f ewer manual removals of the placenta, compared with women without trea tment (odds ratio [OR] 11.6, 99% confidence interval [CI] 1.4, 272.8; and OR 7.4, 99% CI 1.1, 86.5; respectively). When women given intraumb ilical oxytocin were compared with women given only intraumbilical sal ine, the difference was not statistically significant (OR 6.6, 99% CI 0.9, 77.2 for spontaneous expulsion of the placenta; and OR 4.7, 99% C I 0.8, 39.5 for manual removal). There was no significant difference i n the incidence of spontaneous expulsion and manual removal of the pla centa between women given intraumbilical saline injection and women wi thout treatment (OR 1.8, 99% CI 0.1, 53.9; and OR 1.6, 99% CI 0.1, 22. 4; respectively). Conclusion: The results of our study suggest a clini cally important beneficial effect of intraumbilical oxytocin injection in the management of retained placenta. (C) 1998 by The American Coll ege of Obstetricians and Gynecologists.