The Efficacy of Intra-umbilical Vein Administration of Carboprost Versus Oxytocin in the Management of Retained Placenta: Surgical and Non-Surgical Risk Factors

Abstract

Background: Retained placenta is one of the major causes of primary and secondary post-partum hemorrhage (PPH) and active management of the third stage of labor reduces the risk of PPH. Objective: The aim of this paper was to compare the efficacy of intra-umbilical vein injection of carboprost versus oxytocin by time and success rates of total expulsion of the placenta. Methods: This prospective clinical study with quasi-experimental design 2x2x2(risk factors by medication by doses) was conducted at Clinic of Obstetrics and Gynecology, Clinical Center of University of Sarajevo in two-year period. Patients were randomized in 4 groups and 8 subgroupsby different medication doses and risk factors. The main outcome variable was expulsion of retained placenta and second outcome variables were: duration of time from intra-umbilical vein administration of drug to expulsion of retained placenta, the number of cases who required blood transfusion and antibiotics, postpartum hemoglobin after 24h. Statistical significance was accepted for p-values < 0.05. Results: The group B2 (UVI oxytocin 20 IU in 20 mL saline, surgical risk factors) and the group D2 (UVI oxytocin 20 IU in 20 mL saline, non-surgical risk factors) had shorter expulsion time (minutes) (Me=5; IQR=4 to 5; Me=5; IQR=4.3 to 6, respectively) compared with other groups (p<0.001). The success rates of total expulsion of the placenta by groups (A,B,C and D) were not statistically significant (70% vs. 82% vs. 72% vs. 78%, respectively; p=0.483). Post-intervention hemoglobin concentrations was statistically significantly greater in the group B(117.3±1.3) vs. the group A (112.1±1.3), (p =0.028). Conclusion: The time for placental expulsion was significantly shorter and postpartum hemoglobin was significantly higher in the intra-umbilical oxytocin groups than in the carboprost groups.