RHL Commentary by Manorama Purwar
EVIDENCE SUMMARY
In the management of retained placenta, injection of saline (with or without oxytocics) into the umbilical vein was compared with expectant management, on the one hand, and with injection into umbilical vein of an alternative solution, on the other. Compared to expectant management, the injection of saline solution with oxytocin showed a reduction in the rate of manual removal of the placenta but the difference was marginally nonsignificant statistically (relative risk: 0.86; 95% confidence interval: 0.72 to 1.01). Compared to injection of saline solution alone, injection of saline solution with oxytocin showed a statistically significant reduction in the rate of manual removal of the placenta (RR: 0.79; 95% CI: 0.69 to 0.91). However, there was no difference between the two groups in terms of length of third stage of labour, blood loss, haemoglobin, need for blood transfusion, curettage, infection, hospital stay, fever, abdominal pain and oxytocin augmentation. Comparison of saline solution plus prostaglandin and saline solution plus oxytocin found no statistically significant differences for the above outcomes.
All randomized controlled trials that could be identified using the standard search strategy were included and appropriately analysed. However, I should like to draw the readers attention to my following concerns:
- The strategy for identifying controlled trials should have included contacting experts and regional institutions for help in identifying more trials.
- For certain parameters, such as postpartum haemorrhage, infection and length of the third stage of labour, summary measures (Relative Risks) are calculated on the basis of results of single studies.
- Data extraction and assessment of trial quality was done by two reviewers: the inter-observer reliability or agreement between the two reviewers should have been commented on by the authors.
The full RHL commentary also includes sections on: Relevance
- Magnitude of the problem
- Feasibility of the intervention
- Applicability of the results of the Cochrane Review
- Implementation of the intervention
- Research
References
This document should be cited as: Manorama Purwar. Injection into umbilical vein for management of retained placenta: RHL commentary (last revised: 15 January 2002). The WHO Reproductive Health Library, No 9, Update Software Ltd, Oxford, 2006. www.rhlibrary.com
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