Prostaglandins for management of retained placenta

• Published in: Cochrane database of systematic reviews 2014-05 (5), p.CD010312
• Main Authors: Grillo-Ardila, Carlos F, Ruiz-Parra, Ariel I, Gaitán, Hernando G, Rodriguez-Malagon, Nelcy
• Format: Article
• Language: English
• Subjects: Abortifacient Agents, Nonsteroidal - adverse effects; Abortifacient Agents, Nonsteroidal - therapeutic use; Dinoprostone - adverse effects; Dinoprostone - analogs & derivatives; Dinoprostone - therapeutic use; Female; Humans; Labor Stage, Third; Misoprostol - adverse effects; Misoprostol - therapeutic use; Oxytocics - adverse effects; Oxytocics - therapeutic use; Placenta, Retained - drug therapy; Pregnancy; Prostaglandins - adverse effects; Prostaglandins - therapeutic use; Randomized Controlled Trials as Topic
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD010312.pub2

Retained placenta affects 0.5% to 3% of women following delivery and it is a major cause of maternal death due to postpartum haemorrhage. Usually, retained placenta has been managed by manual removal or curettage under anaesthesia, which may be associated with haemorrhage, infection and uterine perforation. Medical management to facilitate the delivery of the retained placenta could be a safe alternative avoiding surgical intervention. To assess the effectiveness and safety of prostaglandins for the management of retained placenta. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 December 2013), LILACS (1982 to 1 December 2013), SciELO (1998 to 1 December 2013), Web of Science (2001 to 1 December 2013), openSIGLE (1997 to 1 December 2013), World Health Organization International Clinical Trials Registry Platform (ICTRP) (1 December 2013) and the metaRegister of Controlled Trials (mRCT) (1 December 2013). We also contacted authors of included studies and reviewed the reference lists of retrieved studies. Randomised controlled clinical trials comparing the use of prostaglandins (or prostaglandin analogues) with placebo, expectant management, tocolytic drugs, any other prostaglandins or surgical interventions for the management of retained placenta after vaginal delivery of singleton live infants of 20 or more weeks of gestation. Two review authors independently assessed trials for inclusion and assessed trial quality. Two review authors independently extracted data. Data were checked for accuracy. Any disagreements were resolved through consensus or consultation with a third review author when required. Authors of the included studies were contacted for additional information. We included three trials, involving 244 women. The studies were considered to be at high risk of bias.The prostaglandins used were PG E2 analogue (sulprostone) in 50 participants and PG E1 analogue (misoprostol) in 194 participants at a dose of 250 mcg and 800 mcg respectively. The prostaglandins compared with placebo, were not superior in reducing the rate of manual removal of placenta (average risk ratio (RR) 0.82; 95% confidence interval (CI) 0.54 to 1.27), severe postpartum haemorrhage (RR 0.80; 95% CI 0.55 to 1.15), need for blood transfusion (RR 0.72; 95% CI 0.43 to 1.22), mean blood loss (mean difference (MD) -205.26 mL; 95% CI -536.31 to 125.79, random-effects) and the mean time from injection to placental removal (MD -7.00 minutes; 95% CI -21.20 to