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

Medications that can stimulate contraction of the myometrium with sufficient strength to induce separation of the placenta have been studied as potential options for the management of retained placenta as alternatives to manual removal in cases where the placenta has been determined to be retained. These medications could be used in patients whose labour has already been managed actively with oxytocin or in patients who have received expectant care (i.e, no active management). Ergometrine and prostaglandins are examples of medications that can all induce sustained contractions of the myometrium. Injection into the umbilical vein has been studied as a route of administration with a number of different medications, including misoprostol, a synthetic analogue of prostaglandin E1. The umbilical vein route delivers the medication directly to the placenta and uterine wall. Misoprostol is currently available in Canada in tablet form and is approved for use for the prevention of treatment and prevention of NSAID-induced gastroduodenal ulcers and the treatment of duodenal ulcers, but not as a uterotonic agent. This report with review the evidence of clinical effectiveness of umbilical vein injection with misoprostol for the management of retained placenta and evidence-based guidelines regarding its use.

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