Intraumbilical injection of three different uterotonics in the management of retained placenta

Aim To compare the effect of intraumbilical injection of three different uterotonic solutions in the management of retained placenta. Methods 78 women with retained placenta (>30 min after delivery of the fetus) were included in the study and randomised into three groups. Each group was injected with a different type of uterotonic into the umbilical vein after clamping it using Pipingas technique. Uterotonics used were either 20 IU oxytocin dissolved in 30 ml saline (n=26), ergometrine 0.2 mg dissolved in 30 ml saline (n=27) or misoprostol 800 µg dissolved in 30 ml saline (n=25). Results The overall success rate of spontaneous placental separation within 30 min after intraumbilical injection of uterotonics was 56/78 (71.79%). The success rate was higher with misoprostol when compared to oxytocin and ergometrine but the difference was not significant (20/25 (80%), 19/26 (73.08%), 17/27 (62.96%), respectively p>0.05). The injection-to-separation interval was significantly shorter in misoprostol group than in oxytocin and ergometrine groups (7.0 ± 2.2 min, 13.14 ± 3.76 min, 22.5 ± 4.37 min, respectively, p<0.001). Conclusion Intraumbilical injection of uterotonics, namely oxytocin, ergometrine and dissolved misoprostol in saline are closely effective in the management of retained placenta, with misoprostol being slightly more effective. This method may have a role in minimising the need for manual removal of the placenta and its adverse sequelae.