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Intra-umbilical vein injection and retained placenta: evidence from a collaborative large randomised controlled trial. Grupo Argentino de Estudio de Placenta Retenida.

AbstractOBJECTIVE:
To determine whether intra-umbilical vein injection with saline solution, with or without oxytocin, reduces the need for manual removal of placenta compared with expectant management.
DESIGN:
Multicenter, randomised controlled trial.
SETTING:
Eleven hospitals in four cities of Argentina: Buenos Aires, Corrientes, Rosario, and Salta.
PARTICIPANTS:
Two hundred and ninety-one women showing no evidence of placental separation thirty minutes after vaginal delivery.
INTERVENTIONS:
Three different management strategies: 1. intra-umbilical vein injection of saline solution plus oxytocin; 2. intra-umbilical vein injection of saline solution alone; and 3. expectant management.
MAIN OUTCOME MEASURES:
Primary: manual removal of the placenta. Secondary: blood loss after trial entry, haemoglobin level at 24 to 48 hours and at 40 to 45 days after delivery, blood transfusion, curettage, infection, and days of hospital stay.
RESULTS:
Rates of subsequent manual removal were similar: intra-umbilical vein injection of saline solution plus oxytocin (58%; RR 0.92; 95% CI 0.73-1.15), or saline alone (63%; RR 1.00; 95% CI 0.80-1.24), compared with expectant management (63%). There were also no detectable effects of the active managements on any of the secondary measures of outcome.
CONCLUSIONS:
Based on evidence available from randomised controlled trials, including this trial, it is unlikely that intra-umbilical injection with or without oxytocin, is clinically useful. We recommend that this intervention should not be used in third stage management of labour.
AuthorsG Carroli, J M Belizan, A Grant, L Gonzalez, L Campodonico, E Bergel
JournalBritish journal of obstetrics and gynaecology (Br J Obstet Gynaecol) Vol. 105 Issue 2 Pg. 179-85 (Feb 1998) ISSN: 0306-5456 [Print] England
PMID9501783 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Chemical References
  • Sodium Chloride
  • Oxytocin
Topics
  • Female
  • Follow-Up Studies
  • Humans
  • Injections, Intravenous
  • Oxytocin (administration & dosage)
  • Placenta, Retained (prevention & control)
  • Pregnancy
  • Sodium Chloride (administration & dosage)
  • Treatment Outcome
  • Umbilical Veins

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