sulprostone and Placenta--Retained

Retained placenta affects 0.5% to 3% of women following delivery and it is a major cause of maternal death due to postpartum haemorrhage. Usually, retained placenta has been managed by manual removal or curettage under anaesthesia, which may be associated with haemorrhage, infection and uterine perforation. Medical management to facilitate the delivery of the retained placenta could be a safe alternative avoiding surgical intervention.. To assess the effectiveness and safety of prostaglandins for the management of retained placenta.. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 December 2013), LILACS (1982 to 1 December 2013), SciELO (1998 to 1 December 2013), Web of Science (2001 to 1 December 2013), openSIGLE (1997 to 1 December 2013), World Health Organization International Clinical Trials Registry Platform (ICTRP) (1 December 2013) and the metaRegister of Controlled Trials (mRCT) (1 December 2013). We also contacted authors of included studies and reviewed the reference lists of retrieved studies.. Randomised controlled clinical trials comparing the use of prostaglandins (or prostaglandin analogues) with placebo, expectant management, tocolytic drugs, any other prostaglandins or surgical interventions for the management of retained placenta after vaginal delivery of singleton live infants of 20 or more weeks of gestation.. Two review authors independently assessed trials for inclusion and assessed trial quality. Two review authors independently extracted data. Data were checked for accuracy. Any disagreements were resolved through consensus or consultation with a third review author when required. Authors of the included studies were contacted for additional information.. We included three trials, involving 244 women. The studies were considered to be at high risk of bias.The prostaglandins used were PG E2 analogue (sulprostone) in 50 participants and PG E1 analogue (misoprostol) in 194 participants at a dose of 250 mcg and 800 mcg respectively. The prostaglandins compared with placebo, were not superior in reducing the rate of manual removal of placenta (average risk ratio (RR) 0.82; 95% confidence interval (CI) 0.54 to 1.27), severe postpartum haemorrhage (RR 0.80; 95% CI 0.55 to 1.15), need for blood transfusion (RR 0.72; 95% CI 0.43 to 1.22), mean blood loss (mean difference (MD) -205.26 mL; 95% CI -536.31 to 125.79, random-effects) and the mean time from injection to placental removal (MD -7.00 minutes; 95% CI -21.20 to 7.20). Side-effects were no different between groups (vomiting, headache, pain and nausea between injection and discharge from the labour ward), with the exception of shivering, which was more frequent in women receiving prostaglandins (RR 10.00; 95% CI 1.40 to 71.49). We did not obtain any data for the primary outcomes of maternal mortality and the need to add another therapeutic uterotonic.. Currently there is limited, very low-quality evidence relating to the effectiveness and the safety using prostaglandins for the management of retained placenta. Use of prostaglandins resulted in less need for manual removal of placenta, severe postpartum haemorrhage and blood transfusion but none of the differences reached statistical significance. Much larger, adequately powered studies are needed to confirm that these clinically important beneficial effects are not just chance findings.Similarly, no differences were detected between prostaglandins and placebo in mean blood loss or the mean time from injection to placental removal (minutes) or side-effects (vomiting, headache, pain and nausea between injection and discharge from the labour ward) except for 'shivering' which was more frequent in women who received prostaglandin. The included studies were of poor quality and there is little confidence in the effect estimates; the true effect is likely to be substantially different. We can not make any recommendations about changes to clinical practice. More high-quality research in this area is needed.

Topics: Abortifacient Agents, Nonsteroidal; Dinoprostone; Female; Humans; Labor Stage, Third; Misoprostol; Oxytocics; Placenta, Retained; Pregnancy; Prostaglandins; Randomized Controlled Trials as Topic

The purpose of this study was to determine the extent that the administration of sulprostone reduces the need for manual removal of the placenta in patients with retained placenta.. A double-blinded sequential randomized controlled trial of sulprostone versus placebo was conducted among 103 patients with retained placenta.. In the first phase of this sequential study, sulprostone was compared with placebo. The null hypothesis of equal effectiveness of both treatments was rejected after 50 patients. In patients with retained placenta, the placenta was expelled after sulprostone in 13 of 24 cases (51.8%, bias adjusted), whereas expulsion after placebo was achieved in only 4 of 26 cases (17.6%, bias adjusted). The difference was significant (P = .034). In the second phase of the study, in which the placebo arm was stopped, results were confirmed; in 25 of 53 patients (47%), the placenta was expelled.. Sulprostone reduces the need for the manual removal of the placenta by 49%.

Topics: Abortifacient Agents, Nonsteroidal; Adult; Dinoprostone; Double-Blind Method; Female; Humans; Infusions, Intravenous; Placenta, Retained; Pregnancy

Consecutive intra-umbilical vein injection of misoprostol and intravenous sulprostone in the management of retained placenta (RP).. The general accepted treatment of RP is manual removal of the placenta (MRP), but medical intervention protocols were suggested. We evaluate a protocol of using intra-umbilical vein injection of misoprostol followed, if necessary, by intravenous sulprostone. A reduction in the need for MRP and less blood loss was expected.. Cohort A (1 January 2007 to 31 September 2008), managed by an expectative protocol including active management of the third stage of labor and if necessary MRP performed 60 min after birth of the baby, was compared with cohort B (1 April 2009 to 31 December 2010) managed by medical intervention protocol. This protocol consisted of intra-umbilical vein injection of misoprostol and if not successful, 250 μg of sulprostone was given intravenously in 30 min. All vaginal deliveries after 24 weeks of gestation, with RP after 20 min and blood loss <500 mL were included. An intention to treat analysis was performed, with the need for MRP as the primary outcome.. Baseline characteristics were similar. In cohort A, 275 women met the inclusion criteria and 57 (20.7%) women needed MRP. In cohort B, 219 women were included and 35 (16%) women needed MRP. There was no significant difference in number of MRP, the amount of blood loss and other secondary outcomes.. We conclude that the use of intra-umbilical vein injection of misoprostol and intravenous sulprostone consecutively, does not reduce the number of MRPs as well as the total amount of blood loss in women with RP after 20 min. The study shows that changing obstetric management by extrapolating results from specific study groups to a general population may lead to other results.

Topics: Administration, Intravenous; Adult; Dinoprostone; Female; Humans; Misoprostol; Oxytocics; Placenta, Retained; Pregnancy; Retrospective Studies; Treatment Outcome; Umbilical Veins

Guidelines for the management of post-partum haemorrhage (PPH) were defined by the "Collège National des Gynécologues Obstétriciens Français (CNGOF)" since 2004. The aim of this work was to assess whether the management of PPH before and during the transfer was in accordance with national recommendations.. This is an observational monocentric prospective study concerning 84 patients transferred for PPH in a referent centre in 2011.. In 62 cases (73.8%), transfusionnal files were found. Time noted PPH for 60 (71.4%) and amount of blood loss in 55 cases (65.5%) were notified. Evacuation of retained placenta was always performed; the broad-spectrum antibiotic prophylaxis covered only 21 cases of intra uterine procedures. Less than 5% of the patients received intravenous sulprostone before the transfer; 72.6% (n=61) of the patients were transfused before transfer 25% of the patients (n=21) had a very high risk of PPH in ante partum and were not addressed to a centre with appropriate medical and technical facilities.. Thus improvement can be made in the communication between the health care centre during transfer for PPH and the ante partum transfer of patients with high risk of PPH.

Topics: Adult; Antibiotic Prophylaxis; Blood Transfusion; Dinoprostone; Female; Gynecology; Humans; Middle Aged; Obstetrics; Patient Transfer; Placenta, Retained; Postpartum Hemorrhage; Practice Guidelines as Topic; Pregnancy; Prospective Studies

To analyze the effectiveness of intravenous sulprostone infusion for the treatment of retained placenta without massive primary hemorrhage among women at an university hospital over a three-year period.. Retrospective observational study.. University teaching hospital.. 126 consecutive women with placental retention and intravenous sulprostone infusion as primary treatment performed from October 2007 up to December 2011.. Hospital records of women who received sulprostone infusion to attempt placental expulsion were reviewed.. Primary endpoints of the study were expulsion of placenta and the total amount of blood loss during delivery.. The placenta was successfully expelled in 39.7% of cases, whereas 60.3% of women underwent manual removal of placenta. Blood loss was significantly lower in women with successful placental expulsion than in women who had manual removal of the placenta (582 ± 431 ml vs. 1275 ± 721 ml, p < 0.0001). Sulprostone infusion did not cause adverse effects or significant postpartum morbidity.. Intravenous sulprostone infusion is safe and reduces both blood loss and the need for manual removal of the placenta.

Topics: Abortifacient Agents, Nonsteroidal; Adult; Dinoprostone; Female; Finland; Humans; Infusions, Intravenous; Male; Placenta, Retained; Postnatal Care; Postpartum Hemorrhage; Postpartum Period; Pregnancy; Retrospective Studies; Treatment Outcome; Young Adult

The aim of the study is to assess the compliance rate of treatment of postpartum hemorrhage (PPH) according to guidelines developed by the CNGOF within our network by a first audit, and evaluate the impact of this first audit by conducting a second audit.. An initial audit of resources and management of postpartum hemorrhage (PPH) was conducted in 2006-2008 in 24 maternity hospitals of the Pays-de-la-Loire. The audit had identified six areas for improvement. A second audit was implemented in 2009-2010 to evaluate the actions of prevention and measure changes in the management of PPH. Two interns have distributed the 24 maternity homes and moved in each hospital to see 10 cases of vaginal delivery (VD) (section "Prevention"), and the last cases of PPH following a VD. The results are in compliance rate compared to the repository of the HAS in 2004.. The first audit was conducted on 101 PPH in total. It has allowed us to propose corrective actions to the 24 maternity hospitals: leaf specific monitoring, reporting amounts of blood loss, transfusion on these clinical criteria without waiting for the blood cell counts, indicating more frequent and rapid sulprostone, set for maternity hospitals without surgical skill an agreement with a visceral surgery department, and avoid maternal transfers for PPH. For the second audit, the compliance rate of the preventive aspect was 73% (95: 71-75%) of 239 cases of BA with variations according to maternity from 48 to 93%. Compliance rates according to the criteria were: 99% obstetric consultations, 98% for anesthesia, 92% for hemoglobin, 77% for the group card available in the record, 89% agglutinins, 35% for the notification of the installation of bag, 36% for the notification of the amount of blood lost, 69% for the supervisor within two hours, and 64% for the directed delivery. For component "Support", the overall compliance rate was 81% (95: 79-83%) of 118 PPH AVB, and 85% in the 71 uterine atonies in 21 pregnancies (3 had no HPP during the period) with variations according to maternity from 51 to 93%. Conformities compared with the first audit were: improvement of time noted PPH (66 and 85%), initiation of a leaf-specific monitoring (0% and 87%), equivalence of appeals responders (86 and 88%), improving the amount of blood noted (51 and 67%), equivalent to the practice of evacuation of retained placenta (88 and 91%), decreased prescription of antibiotics (83 and 71%). For only uterine atony (n=71), there was a slight improvement in the prescription of sulprostone within 30 minutes (53 and 58%), and improved decision within 2 hours (47 and 69%). Finally, there was no connection rates in the two components (r=0.32, p=0.15). Criteria associated with good compliance were calculated.. There is a general improvement in prevention and care, with critical points and persistent disparities between pregnancies. In the aftermath of the completion of the audit, the overall results were sent to officials with the rank of each maternity, inviting each responsible to analyze weaknesses and implement corrective actions. Further action is planned within the network.

Topics: Abortifacient Agents, Nonsteroidal; Adult; Anti-Bacterial Agents; Delivery, Obstetric; Dinoprostone; Female; France; Hospitals, Maternity; Humans; Medical Audit; Placenta, Retained; Postpartum Hemorrhage; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Uterine Inertia

Topics: Abortifacient Agents, Nonsteroidal; Dinoprostone; Female; Humans; Placenta, Retained; Pregnancy; Randomized Controlled Trials as Topic

To obtain insight into treatment duration and complications of the currently accepted method for pregnancy termination in the second trimester using a combination of prostaglandine-E2 medications.. Retrospective study of medical records.. Data were collected for all second trimester pregnancy terminations performed on foetal indication in the Erasmus Medical Center in Rotterdam, The Netherlands, in the years 1998-2001. The treatment consisted of vaginal administration of dinoprostone, followed by intravenous administration of sulprostone.. A total of 134 pregnant women were involved in the analysis. The median age was 33 years and the median pregnancy duration 19 weeks. The median duration of hospital stay was 3 days (range: 2-11 days). The median duration of treatment for the total study population was 19 hours (4-172). For nulliparae this was 23 hours, and for multiparae 17 hours (p < 0.05). Of the total study population, 91 women (68%) delivered within 24 hours. The percentage of multiparae that delivered within 24 hours was higher than the percentage of nulliparae that delivered in this time (76% compared to 53%: p < 0.05). Operative removal of a--partially--retained placenta was conducted in 51 women (38%). This percentage was higher among women with treatment duration longer than 24 hours than among women who delivered within 24 hours (51% versus 32%; p < 0.05). The treatment duration and the complication percentage were less favourable than those described in a number of publications relating to the combination mifepristone and misoprostol.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Administration, Intravaginal; Adult; Dinoprostone; Female; Fetus; Humans; Placenta, Retained; Pregnancy; Pregnancy Trimester, Second; Retrospective Studies; Time Factors; Treatment Outcome

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Dinoprostone; Female; Humans; Mifepristone; Misoprostol; Placenta, Retained; Pregnancy