Misoprostol administration for the Management of retained placenta

Abstract

Background: Postpartum hemorrhage due to retained placenta remains a major cause of maternal morbidity and mortality in the developing countries. Manual removal of retained placenta is an element of basic EmOC but currently, only 46% of health facilities offering delivery services in Kenya provide this procedure. Therefore, an affordable medical solution which is applicable even in the basic health settings is seriously needed. Objectives: To describe the effect of sublingual misoprostol in the management of retained placenta and associated adverse effects. Methods: This was a cross sectional survey carried out in Pumwani Maternity Hospital involving 50 mothers with retained placenta, and no PPH, recruited through consecutive sampling, from Jan to April 2011. Misoprostol, 600mcg sublingual was administered at enrollment and manual removal was performed if the placenta was not delivered within 30 minutes. Data was collected using an interviewer administered structured questionnaire and was analyzed using SPSS computer package. Results: 84% of the mothers delivered the placenta within 30 minutes. A further 6% delivered the placenta within the next 10 minutes as they awaited manual removal. A history of previous uterine surgery negatively impacted on the outcome. 14% of the mothers reported no side effects, while 60% reported transient chills. Other reported side effects included nausea (14%), abdominal cramps (10%) and vomiting (4%). Conclusion: Sublingual misoprostol 600mcg was effective in reducing the need for manual removal of placenta and its transient side effects were well tolerated Recommendations: Misoprostol should be registered and included in the clinical guidelines for the management of retained placenta. However, further research preferably a large RCT is recommended.