From www.thelancet.com of 9 Jan.
<http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61752-9/abstract?elsca1=TL-090110-EITHEROPENORCLICK&elsca2=email&elsca3=segment>

Strange, I didn't have a picture of numbers of women needing hasty manual 
removal of the placenta, especially as soon as 30 minutes after birth, 
before the body and the breastfeeding has been given a real chance to work. 
This strikes me as a rather impatient piece of research, or is it just me? 
Obviously, limiting postpartum haemorrhage is vital, I concur.

Is anyone able to read the full text - was breastfeeding mentioned at all? 
Interesting that there were more women in UK needing help - one assumes 
there is less skin-to-skin contact and less early breastfeeding in UK, which 
may be unfair.

Jacquie Nutt IBCLC
South Africa

Umbilical vein oxytocin for the treatment of retained placenta (Release 
Study): a double-blind, randomised controlled trial
Dr Andrew D Weeks MRCOG a , Godfrey Alia MMed b, Gillian Vernon MSc a, 
Annette Namayanja MBBS b, Radhika Gosakan MRCOG c, Tayyaba Majeed FCPS d, 
Anna Hart MSc e, Hussain Jafri MBA d, Juan Nardin MD f, Guillermo Carroli MD 
f, Fiona Fairlie FRCOG c, Prof Yasmin Raashid FRCOG d, Prof Florence Mirembe 
PhD b, Prof Zarko Alfirevic FRCOG a

Summary:
Background
Retained placenta is associated with post-partum haemorrhage. Meta-analysis 
has suggested that umbilical injection of oxytocin could increase placental 
expulsion without the need for a surgeon or anaesthetic. We assessed the 
effect of high-dose umbilical vein oxytocin as a treatment for retained 
placenta.

Methods
In this double-blind, placebo-controlled trial, haemodynamically stable 
women with a retained placenta for more than 30 min were recruited from 13 
sites in the UK, Uganda, and Pakistan. 577 women were randomly assigned by a 
computer-generated randomisation list stratified by centre to 30 mL saline 
containing either 50 IU oxytocin (n=292) or 5 mL water (n=285), which was 
injected into the placenta through an umbilical vein catheter. All trial 
participants, study workers, and data handlers were masked to individual 
allocations. The primary outcome was the need for manual removal of the 
placenta. Analysis was by intention to treat. This study is registered, 
number ISRCTN 13204258.

Findings
The primary outcome was recorded for all participants. We detected no 
difference between the groups in the need for manual removal of placenta 
(oxytocin 179/292 [61·3%] vs placebo 177/285 [62·1%]; relative risk 0·98, 
95% CI 0·87-1·12; p=0·84). The need for manual removal was higher in the UK 
(overall 250/361 [69%]) than in Uganda (90/190 [47%]) or Pakistan (16/26 
[62%]). Adverse events did not differ between the two groups.

Interpretation
Umbilical oxytocin has no clinically significant effect on the need for 
manual removal for women with retained placenta.

Funding
WHO, WellBeing of Women, Pakistan Higher Education Commission. 

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