Pharmacologic intervention for retained placenta: a systematic review and meta-analysis.
OBJECTIVE
To assess the effectiveness and safety of pharmacologic interventions for the treatment of retained placenta (when the placenta remains undelivered after 30 minutes of active management of the third stage of labor).


METHODS
We searched: 1) Cochrane Central Register of Controlled Trials (CENTRAL), 2) Cochrane Pregnancy and Childbirth Group's Trials Register, 3) EMBASE, and 4) MEDLINE from inception to June 2014.


METHODS
Randomized controlled trials comparing a pharmacologic intervention(s) with a placebo for the treatment of retained placenta were included.


RESULTS
Sixteen randomized controlled trials, including 1,683 participants, were included. Study characteristics and quality were recorded. The meta-analysis was based on random-effects methods for pooled data. There were no statistically significant differences in the requirement to perform manual removal of a placenta in patients treated with oxytocin (55% compared with 60%; relative risk [RR] 0.86, 95% confidence interval [CI] 0.73-1.02; 10 randomized controlled trials [RCTs]), prostaglandins (44% compared with 55%; RR 0.82, 95% CI 0.58-1.15; four RCTs), nitroglycerin (85% compared with 80%; RR 1.06, 95% CI 0.80-1.41; one RCT), or oxytocin and nitroglycerin (52% compared with 79%; RR 0.23, 95% CI 0.01-8.48; two RCTs) compared with placebo. There was limited reporting of secondary outcomes.


CONCLUSIONS
As opposed to the use of oxytocin as part of the active management of the third stage of labor that has been shown to diminish bleeding in the third stage, once the diagnosis of retained placenta has been made, no pharmacologic treatment has been shown to be effective. When retained placenta is diagnosed, immediate manual removal of the placenta should be considered.


BACKGROUND
PROSPERO International Prospective Register of Systematic Reviews, http://www.crd.york.ac.uk/PROSPERO/, CRD42014010641.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, the Women's Health Research Unit, The Blizard Institute, Barts and the London School of Medicine and Dentistry, London, and the School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom; and the Cochrane Menstrual Disorders and Subfertility Group, University of Auckland, Auckland, New Zealand.
James M N
JMN
Duffy
Sophie
S
Mylan
Marian
M
Showell
Matthew J A
MJA
Wilson
Khalid S
KS
Khan
D005260:Female; D006801:Humans; D018457:Placenta, Retained / Q000188:drug therapy*; D011247:Pregnancy; D017211:Treatment Failure