Intravenous nitroglycerin for controlled cord traction in the management of retained placenta

Objective: To determine the effect of 200 mu g of intravenous nitroglycerin in the release of retained placenta by controlled cord traction. Methods: In this randomized controlled study, 40 women with a placenta retained for 30 minutes received intravenously 200 mu g of nitroglycerin or a normal saline solution before umbilical cord traction was initiated. The rates of successful removal of the retained placenta in the study (n = 20) and control (n = 20) groups were compared, as were blood pressure, pulse rate, blood loss, and adverse effects. Results: The placenta was released in only 15% and 20% of the participants in the study and control group, respectively. The remainder of the participants required general anesthesia and manual removal of the retained placenta regardless of group assignation. Blood pressure fell in significantly more women in the study group, but there were no differences in estimated blood loss or minor adverse effects. Conclusion: Intravenously administered nitroglycerin did not facilitate the release of retained placenta by umbilical cord traction. However, cord traction may be performed longer than 30 minutes to attempt releasing the placenta before operative manual removal is initiated. (C) 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.