Different routes and forms of uterotonics for treatment of retained placenta: a randomized clinical trial.

OBJECTIVES: To compare between three different uterotonics (oxytocin, carbetocin and misoprostol) given via three different routes (intraumbilical, intravenous and sublingual, respectively) in reducing the need for manual removal of placenta (MROP). METHODS: A randomized trial for cases with retained placenta 30 min following vaginal delivery. They received intraumbilical oxytocin, intravenous carbetocin or sublingual misoprostol. Main outcome measures were delivery of the placenta within 30 min following drug administration, and need for MROP. Secondary outcome measures were injection to placental delivery time, post-delivery hemoglobin, need for blood transfusion or additional uterotonics. RESULTS: The overall success rate was 66.7% (64/96), 71.3% (67/94) and 63.7% (58/91) for oxytocin, carbetocin and misoprostol groups, respectively (p > 0.05). When time needed to achieve placental delivery considered, a significant difference was observed with the shortest time for carbetocin (16.61 ± 3.76 min), then oxytocin (18.28 ± 3.34 min) and lastly misoprostol (23.00 ± 3.38 min) (p <0.001). Again, carbetocin group needed less additional uterotonics to achieve adequate uterine contractions (p <0.001). CONCLUSIONS: Although we aimed to exploit the advantage of certain drug over another, all seemed to have close efficacy but it would be important that further research should highlight availability, cost, ease of administration and storage requirements to determine which agent would best be used in this clinical scenario.

Relation between Helicobacter pylori infection and severe pre-eclampsia complicated by intrauterine growth restriction in a rural area in Egypt.

The purpose of this study was to evaluate the association of Helicobacter pylori (HP) infection with severe pre-eclampsia (PE) complicated by intrauterine growth restriction using rapid stool antigen test in a rural area in Egypt. Maternal stool samples were collected from 50 pregnant women diagnosed with PE-associated intrauterine growth restriction (IUGR) and from 50 women with healthy pregnancies (control) between 34 and 38 weeks of gestation. HP stool antigen (HPSA) was measured using a monoclonal antibody test, which is an immuno-chromatographic assay that uses antibody-coated colloidal gold. A significantly higher percentage of HPSA positive women were found among PE cases complicated by IUGR (76%) compared to healthy pregnancies (32%) (p < .0001). However, in the PE/IUGR group, neonatal weight was not significantly lower in HPSA positive patients compared to HPSA negative patients (p = .08). This led to our conclusion that Helicobacter pylori infection has a possible role in the etiopathogenesis of PE with IUGR with no evident effect on its severity.