No reduction of manual removal after misoprostol for retained placenta: a double-blind, randomized trial


  • The authors have stated explicitly that there are no conflicts of interest in connection with this article.


Giel van Stralen, Leiden University Medical Center, Department of Obstetrics K6-27, P.O. Box 9600, 2300 RC Leiden, the Netherlands. E-mail:



To test the effect of 800 μg of misoprostol orally on the prevention of manual removal of retained placenta.


Multicenter, double-blinded, placebo-controlled, randomized trial.


One university and one non-university teaching hospital in the Netherlands.


99 women with retained placenta (longer than 60 min after childbirth) in the absence of postpartum hemorrhage.


Eligible women were administered either 800 μg of misoprostol or placebo orally.

Main outcome measures

Number of manual removals of retained placenta and amount of blood loss.


Manual removal of retained placenta was performed in 50% of the women who received misoprostol and in 55% who received placebo (relative risk 0.91, 95% confidence interval 0.62–1.34). No difference in the amount of blood loss (970 vs. 1120 mL; p = 0.34) was observed between the two groups.


Administration of 800 μg of oral misoprostol, one hour after childbirth, does not seem to reduce the number of manual removals of retained placentas. The time elapsing results in the delivery of 50% of the retained placentas at the expense of an increased risk of postpartum hemorrhage.