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Umbilical Vein Injection of Misoprostol for the Management of Retained Placenta: A Review of Clinical Effectiveness and Guidelines

Last updated: January 23, 2017
Project Number: RC0842-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of umbilical vein injections with misoprostol for the management of retained placenta?
  2. What are the evidence-based guidelines regarding umbilical vein injections with misoprostol for the management of retained placenta?

Key Message

One randomized controlled trial found no statistical difference in the rate of spontaneous placental separation for misoprostol, oxytocin and ergometrine delivered by umbilical vein injection, but a difference in time to spontaneous separation. In one non-randomized, clinical study there were no statistical differences in the rates of manual removal of the placenta between misoprostol and normal saline, and no differences in time until delivery of the placenta. One 2014 evidence-based guideline recommended against the use of any umbilical vein agents for the management of retained placenta; however, the use of misoprostol umbilical vein injection as an alternative to manual removal of the placenta was endorsed in an older guideline from 2009.