Sublingual nitroglycerin seems to be effective in the management of retained placenta.
BACKGROUND
A common approach in the management of retained placenta is administration of oxytocin followed by controlled cord traction. Previously it has also been demonstrated that intravenously administered nitroglycerin facilitates manual extraction of retained placenta. The purpose of the present trial was to examine the success rate and safety of sequential administration of intravenous oxytocin in combination with sublingual nitroglycerin for the delivery of retained placenta.


METHODS
The report is a chart review of 24 women with retained placenta despite intravenously administered oxytocin. The women were given sublingual nitroglycerin (1 mg) to promote detachment of the placenta. Some 5 min after resorption of the tablets, controlled cord traction was carried out for a maximum of 5 min. In addition, changes in blood pressure following treatment with nitroglycerin and total blood loss during delivery were registered.


RESULTS
Twenty-one of the women delivered the placenta successfully following sublingual administration of nitroglycerin. The procedure failed in 3 women and operative manual removal under regional or general anesthesia was undertaken. No complications due to nitroglycerin were registered.


CONCLUSIONS
Sequential administration of oxytocin and nitroglycerin seems to be an effective and safe procedure in the management of retained placenta. However, larger studies are needed to confirm the encouraging results of the present trial.
Ekerhovd
Erling
E
Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden. erling.ekerhovd@obgyn.gu.se
Bullarbo
Maria
M
D000286:Administration, Sublingual; D000328:Adult; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D007275:Injections, Intravenous; D005996:Nitroglycerin / Q000627:therapeutic use*; D010120:Oxytocics / Q000627:therapeutic use; D010121:Oxytocin / Q000627:therapeutic use; D018457:Placenta, Retained / Q000628:therapy*; D011247:Pregnancy; D014143:Traction; D014665:Vasodilator Agents / Q000627:therapeutic use*
D010120:Oxytocics; D014665:Vasodilator Agents; D010121:Oxytocin; D005996:Nitroglycerin