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World J Obstet Gynecol. Aug 10, 2014; 3(3): 124-129
Published online Aug 10, 2014. doi: 10.5317/wjog.v3.i3.124
Retained placenta: Do we have any option?
Pei Shan Lim, Nor Azlin Mohamed Ismail, Nur Azurah Abd Ghani, Nirmala Chandralega Kampan, Aqmar Suraya Sulaiman, Beng Kwang Ng, Kah Teik Chew, Abdul Kadir Abdul Karim, Muhammad Abdul Jamil Mohd Yassin
Pei Shan Lim, Nor Azlin Mohamed Ismail, Nur Azurah Abd Ghani, Nirmala Chandralega Kampan, Aqmar Suraya Sulaiman, Beng Kwang Ng, Kah Teik Chew, Abdul Kadir Abdul Karim, Muhammad Abdul Jamil Mohd Yassin, Department of Obstetrics and Gynecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Kuala Lumpur, Malaysia
Author contributions: All the authors contributed to this paper.
Correspondence to: Pei Shan Lim, Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakob Latif, 56000 Kuala Lumpur, Malaysia. pslim@ppukm.ukm.edu.my
Telephone: +603-91-455950 Fax: +603-91-456672
Received: February 28, 2014
Revised: June 6, 2014
Accepted: July 12, 2014
Published online: August 10, 2014
Processing time: 203 Days and 22.7 Hours
Abstract

Retained placenta is a known cause of post-partum haemorrhage and maternal mortality. A recent systemic review has confirmed that the incidence of retained placenta had increased all over the world, which is more common in developed countries. Failure of retro-placental myometrium contraction is the main cause of retained placenta. Maternal age greater than 35 years, grandmultipara, preterm labor, history of previous retained placenta, and caesarean section were the risk factors for retained placenta. Manual removal of the placenta has been the treatment of choice. Attempts had been made by clinician and researchers to find a safe, effective and reliable method to avoid the need for surgical intervention. The efficacy and safety of prostaglandin, nitroglycerin or acupuncture in the management of retained placenta are yet to be further evaluated. Nonetheless, till date only intra-umbilical vein oxytocin has been studied extensively but with varied success. More randomized clinical trials are needed to address this issue. However, if immediate manual placenta removal service is unavailable, a trial of intra-umbilical vein oxytocin 100 IU at a total volume of at least 40 mL while preparing for transfer to a tertiary center or theatre may result in spontaneous expulsion of the placenta.

Keywords: Retained placenta; Manual removal of the placenta; Intra-umbilical vein; Oxytocin; Prostaglandin; Misoprostol; Carboprost; Acupuncture

Core tip: Retained placenta is a known cause of post-partum haemorrhage and maternal mortality. The incidence of retained placenta had increased all over the world, which is more common in developed countries. Manual removal of the placenta has been the treatment of choice. However, it is a surgical intervention requiring anaesthesia with potential risk and complication. This manuscript reviews various methods that had been reported in the management of retained placenta.