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Injections Aren't Solution for Retained Placenta: Study

Oxytocin shots fail to improve outcome for women with serious childbirth complication

TUESDAY, Dec. 8 (HealthDay News) -- Injections of oxytocin into the umbilical vein don't decrease the need for manual removal in women with a retained placenta after giving birth, according to a new study.

Retained placenta occurs in 0.1 to 2 percent of deliveries, with higher rates in wealthier nations. Without prompt treatment, women with a retained placenta are at high risk of hemorrhage. Currently, treatment involves manual removal of the placenta, which requires an operating room, a surgeon and an anesthetist. But a lack of these resources means that the death rate for retained placenta is nearly 10 percent in rural communities, according to background information in the study.

An effective, cheap and simple treatment is needed. Some had thought that injecting the hormone oxytocin into the umbilical vein could fill this need, the study authors said.

This study included 577 women in Pakistan, Uganda and the United Kingdom who received 30 milliliters of saline containing either water (the placebo group) or 50 international units of oxytocin. The solution was injected into the placenta through an umbilical vein catheter.

The need for manual removal of the placenta was virtually the same for both groups: 61.3 percent for the oxytocin group and 62.1 percent for the placebo group. The researchers also found that the need for manual removal was higher in the United Kingdom (69 percent) than in Pakistan (62 percent) or Uganda (47 percent).

"These findings accord with a review in which rates of retained placenta in the U.K. are seen to be rising with time and seem to be greater in high-resource settings than in low-resource settings," wrote Dr. Andrew D. Weeks, of the University of Liverpool and Liverpool Women's Hospital, and colleagues.

"The reasons for this result are not clear, but it could represent the amount of exertion that is put into removal of the placenta by the attendants," they added. "In settings in which there are long waits for [operating rooms] and in which women are tolerant of pain, there can be many attempts at placental delivery with prolonged cord traction, grasping of vaginal portions of the placenta and uterine massage. In the U.K., by contrast, operating [rooms] with regional anesthesia are easily accessible and so the woman does not need to undergo the discomfort of repeated attempts at placental delivery."

The study authors concluded that their findings "have shown that umbilical vein oxytocin had no significant effect on the need for manual removal of the placenta or any other clinical outcome."

The study was released online Dec. 7 in advance of publication in an upcoming print issue of The Lancet.

More information

The World Health Organization has more about umbilical vein injections for retained placenta.

-- Robert Preidt

SOURCE: The Lancet, news release, Dec. 7, 2009

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