Different routes and forms of uterotonics for treatment of retained placenta: a randomized clinical trial.
OBJECTIVE
To compare between three different uterotonics (oxytocin, carbetocin and misoprostol) given via three different routes (intraumbilical, intravenous and sublingual, respectively) in reducing the need for manual removal of placenta (MROP).


METHODS
A randomized trial for cases with retained placenta 30 min following vaginal delivery. They received intraumbilical oxytocin, intravenous carbetocin or sublingual misoprostol. Main outcome measures were delivery of the placenta within 30 min following drug administration, and need for MROP. Secondary outcome measures were injection to placental delivery time, post-delivery hemoglobin, need for blood transfusion or additional uterotonics.


RESULTS
The overall success rate was 66.7% (64/96), 71.3% (67/94) and 63.7% (58/91) for oxytocin, carbetocin and misoprostol groups, respectively (p > 0.05). When time needed to achieve placental delivery considered, a significant difference was observed with the shortest time for carbetocin (16.61 ± 3.76 min), then oxytocin (18.28 ± 3.34 min) and lastly misoprostol (23.00 ± 3.38 min) (p <0.001). Again, carbetocin group needed less additional uterotonics to achieve adequate uterine contractions (p <0.001).


CONCLUSIONS
Although we aimed to exploit the advantage of certain drug over another, all seemed to have close efficacy but it would be important that further research should highlight availability, cost, ease of administration and storage requirements to determine which agent would best be used in this clinical scenario.
a Obstetrics and Gynaecology Department , Faculty of Medicine, Menoufia University , Shebin Elkom , Egypt.
Mohammad Ahmed
MA
Maher
a Obstetrics and Gynaecology Department , Faculty of Medicine, Menoufia University , Shebin Elkom , Egypt.
Tarek Mohammad
TM
Sayyed
a Obstetrics and Gynaecology Department , Faculty of Medicine, Menoufia University , Shebin Elkom , Egypt.
Nabih Ibrahim
NI
Elkhouly
D061605:Administration, Intravenous; D000286:Administration, Sublingual; D000328:Adult; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D057194:Intention to Treat Analysis; D053208:Kaplan-Meier Estimate; D016595:Misoprostol / Q000008:administration & dosage*; D010120:Oxytocics / Q000008:administration & dosage*; D010121:Oxytocin / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D018457:Placenta, Retained / Q000188:drug therapy*; D011247:Pregnancy; D013997:Time Factors; D014590:Uterine Contraction / Q000187:drug effects; D055815:Young Adult
D010120:Oxytocics; D016595:Misoprostol; D010121:Oxytocin; C020731:carbetocin
Retained placenta; manual removal of placenta; medical treatment; postpartum hemorrhage; third stage complications