Management of retained placenta by umbilical vein injection

A very serious complication of childbirth is retained placenta in which the placenta does not separate from the inside wall of the uterus after an infant is born. Untreated, retained placenta can cause death from uncontrolled bleeding or infection. The conventional method of removing a retained placenta is 'manual removal' (by hand). This procedure is performed under anesthesia and can, itself, lead to serious consequences. The author describes a different approach which does not require manual methods and would eliminate the need for transportation to a specialized facility after delivery. The method relies on the injection of saline (a salt solution) into the umbilical vein, which carries blood within the umbilical cord from the placenta to the fetus during pregnancy. A smaller volume of saline can be used if the hormone oxytocin is given simultaneously; oxytocin causes uterine contractions, and enhances separation of the placenta. A review of the literature concerning the effectiveness of this method is presented. Placentas that remain in place for 15 to 30 minutes after delivery are generally considered 'retained'. Studies have found no apparent adverse effects of umbilical injection of oxytocin. However, manual removal of the placenta may become more difficult after the oxytocin injection. Although the injection of oxytocin into the umbilical vein appears to be a promising method for treating retained placenta, certain aspects of the procedure, such as the effect of the injection of fluid versus specific physiologic actions of the hormone, require further investigation. (Consumer Summary produced by Reliance Medical Information, Inc.)