F-145 Management of Retained Placenta and Postpartum Hemorrhage: A Systematic Review and Meta-analysis.

摘要

Introduction: Retained placenta complicates roughly 2-3% of all vaginal deliveries and is associated with postpartum hemorrhage (PPH). We aimed to determine which intervention is most effective in treating PPH. Methods: Asystematic review of peer-reviewed English-language articles was conducted using PubMed, ClinicalTrials.gov, Cochrane Library, and Scopus. All randomized controlled trials that met our inclusion criteria were compiled and data were abstracted for the meta-analysis. Types of interventions for retained placenta included were intra-umbilical, intramuscular, and intravenous oxytocin; intra-umbilical and sublingual misoprostol; and intravenous and sublingual nitroglycerin. The primary outcomes evaluated were estimated blood loss,(EBL) postpartum hemorrhage (>500mL and >1000 mL), and blood transfusion. Risk ratios and mean differences (with corresponding 95% confidence intervals [CI]) were estimated based on fixed effects analyses or random effects analyses, depending on heterogeneity. Results: The use of any pharmacologic intervention for retained placenta compared to expectant management or placebo was associated with lower EBL (MD-112 ml, 95% CI -146, -78). The oxytocin and misoprostol subgroup analyses reached statistical significance (MD -122 ml, 95% CI -193, -52 and MD -125 ml, 95% CI -167, -84 respectively), while the nitroglycerine subgroup was not statistically different than expectant management or placebo (MD 17 ml, 95%CI -139, 106). There was no difference between any intervention and expectant management or placebo for PPH >500mL(RR 0.88,95%CI 0.61,1.28), PPH >1000mL(RR 0.95, 95% CI 0.72, 1.26), or blood transfusion (RR 0.91, 95% CI 0.65, 1.28). Conclusion: Administration of oxytocin or misoprostol for the management of retained placenta was associated with lower estimated blood loss, although this difference may not be clinically meaningful. However, pharmacologic interventions were not associated with a decrease in the outcomes of postpartum hemorrhage or blood transfusion.