Efficacy of intra-umbilical oxytocin in the management of retained placenta: a randomized controlled trial.
OBJECTIVE
Retained placenta is an important cause of maternal mortality. The present study was aimed to determine the efficacy of umbilical injection of oxytocin as a treatment modality in this condition.


METHODS
This was a single-center randomized controlled trial incorporating 58 women with retained placenta of more than 30 min, equally distributed into two study arms of intra-umbilical injection of oxytocin (50 IU oxytocin diluted with normal saline [NS] to a total volume 30 mL) and intra-umbilical injection of NS (30 mL). Primary outcome was expulsion of the placenta within 30 min following intervention. All the data were analyzed on an intention-to-treat basis.


RESULTS
The success rate in the intra-umbilical oxytocin group was 51.72% compared to 20.69% in the control arm. This difference in the primary outcome was statistically significant with a P-value<0.05 (P=0.014) favoring intra-umbilical oxytocin infusion with an efficacy rate of 1.5 and a number-needed-to-treat of 3. The peripartum bleeding complications were more in the NS group with a statistically higher (P<0.001) requirement of extra oxytocin to control post-partum bleeding. There were no differences between the two groups in respect to other secondary outcomes, such as post-partum fever, antibiotic requirement and hospital stay.


CONCLUSIONS
Umbilical vein injection of 50IU oxytocin in 30mL of NS delivered effectively via the umbilical cord with milking in cases of retained placenta seems a simple and promising technique to reduce the incidence of a potentially morbid procedure and other complications.
Departments of Gynaecology & Obstetrics Community Medicine, North Bengal Medical College & Hospital, Sushrutanagar Department of Cardiology, IPGMER & SSKM Hospital, Kolkata, West Bengal, India. drajanta@gmail.com
Ajanta
A
Samanta
Samir Ghosh
SG
Roy
Pallab Kumar
PK
Mistri
Anirban
A
Mitra
Ranjan
R
Pal
Animesh
A
Naskar
Sanjay Kumar
SK
Bhattacharya
Partha Pratim
PP
Pal
Arindam
A
Pande
D000328:Adult; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D010120:Oxytocics / Q000008:administration & dosage / Q000627:therapeutic use*; D010121:Oxytocin / Q000008:administration & dosage / Q000627:therapeutic use*; D018457:Placenta, Retained / Q000188:drug therapy*; D011247:Pregnancy; D016896:Treatment Outcome; D014471:Umbilical Veins
D010120:Oxytocics; D010121:Oxytocin