Administering high-does oxytocin via the umbilical vein doesn’t help with removal of retained placenta, according to a controlled trial.

Retained placenta is a complication in a significant minority deliveries and may cause post-partum haemorrhage if not promptly treated; however treatment requires facilities that may not be readily available, especially in resource-poor settings. A simple, low-cost treatment intervention would be a significant advance: some evidence suggests that direct injection of oxytocin via the umbilical vein may assist in expulsion and this trial was intended to investigate its efficacy. It was carried out in University hospitals across a range of settings (UK, Pakistan, and Uganda), and participants were women with retained placenta for at least 30 minutes who were otherwise stable. They were randomised to receive 30ml saline containing either oxytocin 50 units or 5ml saline as placebo, given by direct injection into the placenta via the umbilical vein. Primary outcome was the need for manual removal of the placenta, and analysis was by intention to treat.

The total number screened was not recorded, however 577 women were enrolled in the trial, 292 to oxytocin and 285 to placebo. There was no significant difference between the group in the primary outcome, which occurred in occurred in 179 (61%) women in the umbilical oxytocin group and in 177 (62%) in the placebo group (relative risk 0.98, 95% CI 0.87 to 1.12). There were also no significant differences between the groups in the secondary outcomes studied, or in adverse effects.

The authors conclude that their study showed that oxytocin delivered to the retained placenta via the umbilical vein had no significant effect on the need for manual removal, or on any of the other clinical outcomes studied. They added their results to previous work in a meta-analysis and confirmed that the overall evidence does not support this as an effective intervention.

An accompanying Comment discusses the trial.