Systematic review of prostaglandin analogues for retained placenta.

BACKGROUND: Medical management of retained placenta could be a safe alternative to manual removal. OBJECTIVE: To evaluate the efficacy of prostaglandin analogues for retained placenta. SEARCH STRATEGY: MEDLINE, EMBASE, CENTRAL, ICTRP, LILACS, and OpenSIGLE were searched without language restrictions from inception to January 31, 2017, by combining terms for retained placenta and prostaglandin analogues. SELECTION CRITERIA: Randomized controlled trials comparing prostaglandin analogues with any other intervention. DATA COLLECTION AND ANALYSIS: Trials were independently assessed for inclusion, data extraction, and risk of bias. Data were extracted for meta-analyses. GRADE was used to evaluate the quality of data. MAIN RESULTS: Seven randomized controlled trials (851 patients) were included. Prostaglandins did not increase the placenta expulsion rate (relative risk [RR] 1.40, 95% confidence interval [CI] 0.83-2.36) or decrease maternal transfusion (RR 0.72, 95% CI 0.43-1.22). In comparison with oxytocin, prostaglandins did not modify the expulsion rate (RR 1.26, 95% CI 0.90-1.78), maternal transfusion (RR 1.05, 95% CI 0.27-4.09), or time for delivery of placenta (mean difference -1.56 minutes, 95% CI, -9.25-6.13). Three trials comparing prostaglandins with oxytocin agonists, ergometrine, and manual removal reported similar results. CONCLUSIONS: Prostaglandin analogues do not offer an effective alternative for management of retained placenta.

A randomized comparison of rectal misoprostol with syntometrine on blood loss in the third stage of labour / Comparación randomizada del misoprostol rectal con la sintometrina en la pérdida de sangre en la tercera etapa del parto

OBJECTIVES: a) To compare the clinical effect of rectal misoprostol with intramuscular syntometrine in reducing blood loss in the third stage of labour, b) to determine the severity and incidence of side effects of both drugs and c) to measure blood loss, patient tolerance and acceptance of rectal misoprostol. METHODS: One hundred and forty parturients were randomly allocated to receive intramuscular syntometrine (syntocinon 10 IU + ergometrine 0.5 mg) or rectal misoprostol 400 ?g within five minutes of the delivery of the anterior shoulder. Blood loss was measured by the use of a plastic collection drape. Additional oxytocic therapy was instituted for uterine atony or if blood loss was in excess of one litre. RESULTS: There was no significant difference in patient demographics of each treatment group (Table 1). There was no difference in mean duration of the third stage of labour (8.4 ± 14 min vs 7.8 ± 6.6 min). The mean blood loss from those parturients receiving misoprostol (180.1 ± 120 mls) was not significantly different (p = 0.5) from those receiving syntometrine (197 ± 176.97 mls) for the active management of the third stage of labour. Treatment with syntometrine was associated with a significant elevation of post-partum systolic blood pressure compared with misoprostol treatment (mean increase 0.57 ± 18.79 mmHg vs -1.43 ± 14.17 mmHg, (mean ± SD), p < 0.04). Rectal misoprostol was well tolerated in 88.5% of participants, 11.4% reported that insertion was uncomfortable, of which 2.8% reported that they would have preferred parenteral drug administration. CONCLUSION: The clinical effect of rectal misoprostol and intramuscular syntometrine were not different at the doses used in the active management of the third stage of labour in this study. Rectal misoprostol was well tolerated by the patients and had a low side effect profile. Blood loss assessment using the blood collection drape is of invaluable benefit in resource-poor settings.

OBJETIVOS: a) Comparar el efecto clínico del misoprostol rectal con la sintometrina intramuscular en la reducción de la pérdida de sangre en la tercera etapa del parto, b) determinar la severidad y la incidencia de los efectos colaterales de ambos medicamentos, y c) medir la pérdida de sangre, la tolerancia de las pacientes y la aceptación del misoprostol rectal. MÉTODOS: Ciento cuarenta parturientas fueron elegidas de forma aleatoria para que recibieran la sintometrina intramuscular (syntocinon 10 IU + ergometrina 0.5 mg) o el misoprostol rectal 400 µg dentro de los cinco minutos de la salida del hombro anterior. Se midió la pérdida de sangre usando una bolsa plástica de recolección de sangre. Se instituyó una terapia oxitócica adicional para la atonía uterina o para el caso de que la pérdida de sangre excediera un litro. RESULTADOS: No hubo diferencia significativa en la demografía de los pacientes de cada grupo de tratamiento (tabla 1). No hubo diferencia en la duración promedio de la tercera etapa del parto (8.4 ± 14 min vs 7.8 ± 6.6 min). La pérdida promedio de sangre de las parturientas que recibieron el misoprostol (180.1 ± 120 mls) no fue significativamente diferente (p = 0.5) de las que recibieron sintometrina (197 ± 176.97 mls) para el tratamiento activo de la tercera etapa del parto. El tratamiento con sintometrina estuvo asociado con una elevación significativa de la presión sistólica postparto comparada con el tratamiento con misoprostol (aumento promedio 0.57 ± 18.79 mmHg vs -1.43 ± 14.17 mmHg, (media ± sd), p < 0.04). El misoprostol rectal fue bien tolerado por el 88.5% de las participantes, 11.4% reportaron que la inserción fue incómoda, y de ellas 2.8% reportó que hubieran preferido una administración parenteral del medicamento. CONCLUSIÓN: El efecto clínico del misoprostol rectal y el de la sintometrina intramuscular, no fueron diferentes en las dosis usadas en el tratamiento activo de la tercera etapa del parto en este estudio. El misoprostol rectal fue bien tolerado por las pacientes y tuvo un perfil de efecto colateral bajo. La evaluación de la pérdida de sangre utilizando una bolsa de recolección de sangre posee un valor inapreciable en escenarios de recursos pobres.

A randomized comparison of rectal misoprostol with syntometrine on blood loss in the third stage of labour.

OBJECTIVES: a) To compare the clinical effect of rectal misoprostol with intramuscular syntometrine in reducing blood loss in the third stage of labour b) to determine the severity and incidence of side effects of both drugs and c) to measure blood loss, patient tolerance and acceptance of rectal misoprostol. METHODS: One hundred and forty parturients were randomly allocated to receive intramuscular syntometrine (syntocinon 10 IU + ergometrine 0.5 mg) or rectal misoprostol 400 microg within five minutes of the delivery of the anterior shoulder Blood loss was measured by the use of a plastic collection drape. Additional oxytocic therapy was instituted for uterine atony or if blood loss was in excess of one litre. RESULTS: There was no significant difference in patient demographics of each treatment group (Table 1). There was no difference in mean duration of the third stage of labour (8.4 +/- 14 min vs 7.8 +/- 6.6 min). The mean blood loss from those parturients receiving misoprostol (180.1 +/- 120 mls) was not significantly different (p = 0.5) from those receiving syntometrine (197 +/- 176.97 mls) for the active management of the third stage of labour Treatment with syntometrine was associated with a significant elevation of post-partum systolic blood pressure compared with misoprostol treatment (mean increase 0.57 +/- 18.79 mmHg vs -1.43 +/- 14.17 mmHg, (mean +/- SD), p < 0.04). Rectal misoprostol was well tolerated in 88.5% of participants, 11.4% reported that insertion was uncomfortable, of which 2.8% reported that they would have preferred parenteral drug administration. CONCLUSION: The clinical effect of rectal misoprostol and intramuscular syntometrine were not different at the doses used in the active management of the third stage of labour in this study. Rectal misoprostol was well tolerated by the patients and had a low side effect profile. Blood loss assessment using the blood collection drape is of invaluable benefit in resource-poor settings.