Intra-umbilical vein oxytocin in the management of retained placenta. A double blind placebo controlled study

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Abstract
A prospective, double blind, placebo controlled trial of intra-umbilical vein injection of oxytocin (10 i.u.) was designed to assess its value in the management of retained placenta. No difference in outcome was noted between the control and study groups. Approximately half the women in each group required manual removal of the placenta. No complications related to the study procedure were recorded. Retained placenta is rarely defined in the obstetric literature but is generally diagnosed when the third stage of labour has not been completed within 15 minutes of the end of the second stage. Its incidence in two obstetric units in Great Britain in 1983 was 1.5 per cent (Southmead Hospital, Bristol) and 2 per cent (John Radcliffe Hospital, Oxford). Calculations based on these figures suggest that retained placenta will be diagnosed following 12000 deliveries nationally per year. Normally the uterine contractions that occur after the delivery of the baby result in the spontaneous separation of the placenta, The reasons for failure of separation of the placenta are seldom clear but previous retention, curettage, caesarean section and multiparity have all been implicated (Fox, 1972). Retained placenta is managed by manual removal of the placenta under appropriate anaesthesia. The procedure carries the risks of haemorrhage, trauma and sepsis as well as those risks associated with the type of anaesthetic used. Jarcho (1928) described the management of retained placenta with a 300–400 ml 0.9 per cent saline infusion into the umbilical vein. He postulated that subsequent distension of the chorionicvilli promoted placental separation; neither the success rate nor complications of the technique were recorded! More recently Golan et al. (1983) reported that intra-umbilical vein injection of oxytocin (10 i.u.) resulted in spontaneous completion of the third stage of labour within 5 minutes in all the 10 cases treated. In view of the dramatic success reported, a prospective, double blind, placebo controlled trial of intra-umbilical vein injection of 10 i.u. of oxytocin was carried out in two obstetric units to assess the treatment objectively.

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