title: Intravenous nitroglycerin for controlled cord traction in the management of retained placenta.
abstract: OBJECTIVE
  To determine the effect of 200 μg of intravenous nitroglycerin in the release of retained placenta by controlled cord traction.
  
  
  METHODS
  In this randomized controlled study, 40 women with a placenta retained for 30 minutes received intravenously 200 μg of nitroglycerin or a normal saline solution before umbilical cord traction was initiated. The rates of successful removal of the retained placenta in the study (n=20) and control (n=20) groups were compared, as were blood pressure, pulse rate, blood loss, and adverse effects.
  
  
  RESULTS
  The placenta was released in only 15% and 20% of the participants in the study and control group, respectively. The remainder of the participants required general anesthesia and manual removal of the retained placenta regardless of group assignation. Blood pressure fell in significantly more women in the study group, but there were no differences in estimated blood loss or minor adverse effects.
  
  
  CONCLUSIONS
  Intravenously administered nitroglycerin did not facilitate the release of retained placenta by umbilical cord traction. However, cord traction may be performed longer than 30 minutes to attempt releasing the placenta before operative manual removal is initiated.
authors.affiliation: Department of Anesthesia, Siriraj Hospital, Mahidol University, Thailand. sisps@mahidol.ac.th
authors.forename: Shusee
authors.initials: S
authors.lastname: Visalyaputra
authors.forename: Japarath
authors.initials: J
authors.lastname: Prechapanich
authors.forename: Sukanya
authors.initials: S
authors.lastname: Suwanvichai
authors.forename: Suwimol
authors.initials: S
authors.lastname: Yimyam
authors.forename: Ladda
authors.initials: L
authors.lastname: Permpolprasert
authors.forename: Pattipa
authors.initials: P
authors.lastname: Suksopee
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007275:Injections, Intravenous; D005996:Nitroglycerin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018457:Placenta, Retained / Q000188:drug therapy*; D006473:Postpartum Hemorrhage / Q000209:etiology; D011247:Pregnancy; D013997:Time Factors; D014470:Umbilical Cord; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin