This is not the most recent version of the article. View current version (11 MAY 2011)
Intervention Review
Umbilical vein injection for management of retained placenta
Editorial Group: Cochrane Pregnancy and Childbirth Group
Published Online: 21 JAN 2009
Assessed as up-to-date: 5 JUL 2001
DOI: 10.1002/14651858.CD001337
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Database Title
Additional Information
How to Cite
Carroli G, Bergel E. Umbilical vein injection for management of retained placenta. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD001337. DOI: 10.1002/14651858.CD001337.
Publication History
- Publication Status: Edited (no change to conclusions)
- Published Online: 21 JAN 2009
This is not the most recent version of the article.View current version (11 May 2011)
Abstract
Background
If a retained placenta is left untreated, there is a high risk of maternal death. However, manual removal of the placenta is an invasive procedure with its own serious complications of haemorrhage, infection or genital tract trauma.
Objectives
The objective of this review was to assess the use of umbilical vein injection of saline solution alone or with oxytocin in comparison either with expectant management or with an alternative solution or other uterotonic agent for retained placenta. The main comparisons include the following agents: saline solution alone, saline solution plus oxytocin, saline solution plus prostaglandin and plasma expander.
Search strategy
We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register (latest search 20 March 2001).
Selection criteria
Randomised trials comparing umbilical vein injection of saline or other fluids, with or without oxytocics, either with expectant management or with an alternative solution or other uterotonic agent, in the management of retained placenta.
Data collection and analysis
The two reviewers assessed trial quality and extracted data.
Main results
Twelve trials were included. The trials were of variable quality. Compared with expectant management, umbilical vein injection of saline solution alone did not show any significant difference in the incidence of manual removal of the placenta (relative risk (RR): 0.97; 95% confidence interval (CI): 0.83 to 1.14). Umbilical vein injection of saline solution plus oxytocin compared with expectant management showed a reduction in manual removal, although this was not statistically significant (RR: 0.86; 95% CI: 0.72 to 1.01). Saline solution with oxytocin compared with saline solution alone showed a significant reduction in manual removal of the placenta (RR: 0.79; 95% CI: 0.69 to 0.91) (number needed to treat: 8; 95% CI: 5 to 20). No discernible difference was detected in length of third stage of labour, blood loss, haemorrhage, haemoglobin, blood transfusion, curettage, infection, hospital stay, fever, abdominal pain and oxytocin augmentation. Umbilical vein injection of saline solution plus oxytocin compared with umbilical vein injection of plasma expander showed higher, but not statistically significant, incidence of manual removal of placenta (RR: 1.34; 95% CI: 0.97 to 1.85) and no difference in blood loss but there is only one small trial contributing to this comparison. Saline solution plus prostaglandin, compared with saline solution alone, was associated with a statistically significant lower incidence in manual removal of placenta (RR: 0.05; 95% CI: 0.00 to 0.73 ) but no difference was observed in blood loss, fever, abdominal pain, and oxytocin augmentation but there is only one small trial contributing to these results. There were no significant differences between saline solution plus prostaglandin and saline solution plus oxytocin (RR: 0.10; 95% CI: 0.01 to 1.59) but again there is only one small trial contributing to this meta-analysis.
Authors' conclusions
Umbilical vein injection of saline solution plus oxytocin appears to be effective in the management of retained placenta. Saline solution alone does not appear be more effective than expectant management. Further research into umbilical vein injection of oxytocin, prostaglandins or plasma expander is warranted.
Plain language summary
Umbilical vein injection for management of retained placenta
Some evidence that an injection of oxytocin into the umbilical vein may reduce the need for manual removal of retained placenta after childbirth.
The placenta provides nourishment for the baby in the womb (uterus) through the umbilical cord. It is usually delivered shortly after the baby. If the placenta remains in the womb (retained placenta), women have an increased risk of bleeding heavily (haemorrhage), infection and very occasionally death. Manual removal of the placenta involves an operation to remove the placenta, but it can have adverse effects. The review of trials found some evidence that an injection of oxytocin into the umbilical cord may reduce the need for manual removal of the retained placenta. Further research is needed into the effects of injections of oxytocin, or prostaglandin or plasma expander solution.