INTRA-UMBILICAL VEIN INJECTION AND RETAINED PLACENTA - EVIDENCE FROM A COLLABORATIVE LARGE RANDOMIZED CONTROLLED TRIAL

Objective To determine whether intra-umbilical vein injection with sal ine solution, with or without oxytocin, reduces the need for manual re moval of placenta compared with expectant management. Design Multicent re, randomised controlled trial. Setting Eleven hospitals in four citi es of Argentina: Buenos Aires, Corrientes, Rosario, and Salta. Partici pants Two hundred and ninety-one women showing no evidence of placenta l separation thirty minutes after vaginal delivery. Interventions Thre e different management strategies: 1. intra-umbilical vein injection o f saline solution plus oxytocin; 2. intra-umbilical vein injection of saline solution alone; and 3. expectant management. Main outcome measu res Primary: manual removal of the placenta. Secondary: blood loss aft er trial entry, haemoglobin level at 24 to 48 hours and at 40 to 45 da ys after delivery, blood transfusion, curettage, infection, and days o f hospital stay. Results Rates of subsequent manual removal were simil ar: intra-umbilical vein injection of saline solution plus oxytocin (5 8%; RR 0.92; 95% CI 0.73-1.15), or saline alone (63%; RR 1.00; 95% CI 0.80-1.24), compared with expectant management (63%). There were also no detectable effects of the active managements on any of the secondar y measures of outcome. Conclusions Based on evidence available from ra ndomised controlled trials, including this trial, it is unlikely that intra-umbilical injection with or without oxytocin, is clinically usef ul. We recommend that this intervention should not be used in third st age management of labour.