title: Intraumbilical injection of three different uterotonics in the management of retained placenta.
abstract: OBJECTIVE
  The aim of this work was to compare the effect of intraumbilical injection of three different uterotonic solutions in the management of retained placenta.
  
  
  METHODS
  This study was conducted in Ain-Shams University Maternity Hospital, Cairo, Egypt. A total of 78 women with retained placenta (>30 min after delivery of the fetus) were included in the study and subdivided into three groups. Each group was injected with a different type of uterotonic into the umbilical vein after clamping it using the Pipingas technique. Uterotonics used were either 20 IU oxytocin dissolved in 30 mL saline (n=26), ergometrine 0.2 mg dissolved in 30 mL saline (n=27) or misoprostol 800 µg dissolved in 30 mL saline (n=25).
  
  
  RESULTS
  The overall success rate of spontaneous placental separation within 30 min after intraumbilical injection of uterotonics was 56/78 (71.79%). The success rate was higher with misoprostol when compared to oxytocin and ergometrine but the difference was not significant (20/25 [80%], 19/26 [73.08%], 17/27 [62.96%], respectively, P>0.05). The injection-to-separation interval was significantly shorter in the misoprostol group than in the oxytocin and ergometrine groups (7.0±2.2 min, 13.14±3.76 min, 22.5±4.37 min, respectively, P<0.001).
  
  
  CONCLUSIONS
  Intraumbilical injection of uterotonics, namely oxytocin, ergometrine and dissolved misoprostol in saline, are closely effective in the management of retained placenta, with misoprostol being slightly more effective. This method may have a role in minimizing the need for manual removal of the placenta and its adverse sequelae.
authors.affiliation: Ain-Shams University Maternity Hospital, Cairo, Egypt.
authors.forename: Rany
authors.initials: R
authors.lastname: Harara
authors.forename: Sherif
authors.initials: S
authors.lastname: Hanafy
authors.forename: Mahmoud Saad Alsayed
authors.initials: MS
authors.lastname: Zidan
authors.forename: Medhat
authors.initials: M
authors.lastname: Alberry
mesh_terms: D000293:Adolescent; D000328:Adult; D004874:Ergonovine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D016595:Misoprostol / Q000008:administration & dosage / Q000627:therapeutic use; D010120:Oxytocics / Q000008:administration & dosage* / Q000627:therapeutic use; D010121:Oxytocin / Q000008:administration & dosage / Q000627:therapeutic use; D018457:Placenta, Retained / Q000188:drug therapy* / Q000503:physiopathology; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000517:prevention & control; D049590:Postpartum Period; D011247:Pregnancy; D014471:Umbilical Veins; D055815:Young Adult
chemical_list: D010120:Oxytocics; D016595:Misoprostol; D010121:Oxytocin; D004874:Ergonovine