Management of placental retention based on current scientific evidence
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Martínez Martín E, Martínez Galán P, Manrique Tejedor J, Macarro Ruiz D, Miguelez Llamazares L. Manejo de la retención placentaria basado en la evidencia científica actual. Metas Enferm 2013; 16(6):6-12.
Authors
1Eduardo Martínez Martín, 2Paloma Martínez Galán, 3Javier Manrique Tejedor, 4Dolores Macarro Ruiz, 1Lorena Miguelez Llamazares
Position
1Enfermero/a Especialista en Obstetricia y Ginecología (matrona). Servicio de paritorio. Hospital General de Segovia (Segovia).2Enfermera Especialista en Obstetricia y Ginecología (matrona). Servicio de paritorio. Hospital Virgen de la Salud (Toledo).3Enfermero Especialista en Obstetricia y Ginecología (matrona). Servicio de paritorio. Hospital Arnau Vilanova (Lleida).4Enfermera Especialista en Obstetricia y Ginecología (matrona). Servicio de paritorio. Hospital Ciudad de Coria (Cáceres).
Contact address
Eduardo Martínez Martín. Hospital General de Segovia. Ctra. Ávila, s/n. 40002 Segovia.
Contact email: edumartinez25@hotmail.com
Abstract
Method: narrative review where clinical trials and prospective and
retrospective studies were analyzed, as well as bibliographic reviews, protocols, and clinical practice guidelines about the incidence of placental retention, factors with an impact on said incidence, diagnostic methods, associated complications, and its management. The databases searched were: PubMed, Uptodate, Cuiden, Cochrane Plus, Medline, Embase and Academic Google, using and combining the terms “postpartum haemorrhage”, “scientific evidence”, “uterotonics”, “birth”, “hemorragia postparto”, “evidencia científica” and “placental retention”. The search included the years between 1990 and 2012, and the languages of choice were English and Spanish.
Results and conclusions: the incidence of placental retention varies according to population, representing between 0.5 and 3% of all vaginal births, and it can be diagnosed by observing the lack of signs of placental expulsion. When the placenta is attached, manual extraction is the type of treatment with higher success rate, but there are less invasive measures, such as the injection of prostagladins, oxitocyn or plasma- expanding drugs into the umbilical vein. An oxitocyn injection in the umbilical vein within 15-20 minutes post-partum reduces the incidence of manual extraction. Sublingual nitroglycerin showed a clear benefit in terms of reduction of the need to extract the placenta manually. There are no studies with sufficient scientific evidence to support the use of plasma-expanding drugs and prostagladins. Placental retention is an emergency which may occur in the delivery room, and may be occasionally fatal. Therefore, matrons must be aware of the recommendations based on the best available scientific evidence, where an active management of birth is recommended, as it is associated with a reduction in the risk of postpartum hemorrhage (PPH).
Keywords:
birth; placental retention; scientific evidenceuterotonics
Versión en Español
Título:
Manejo de la retención placentaria basado en la evidencia científica actual
