Nitroglycerin may be effective in management of retained placenta

Clinical question: 
How effective are tocolytics in the management of retained placenta in order to reduce the need for manual removal of the placenta?
Bottom line: 
Sublingual nitroglycerin, given when oxytocin failed, seemed to reduce both the need for manual removal of the placenta and blood loss during the third stage of labour when compared with placebo. Sublingual nitroglycerin caused minimal lowering of blood pressure and increased pulse rate. However, its routine use cannot be recommended because of the small sample size of the single study reviewed.
Caveat: 
This review was based on a single, small study. Another limitation of the study was that retained placenta was not specified as detached or non-detached. There is no evidence available for other types of tocolytics.
Context: 
Retained placenta affects 0.5% to 3% of women following delivery, with considerable morbidity, and possible mortality, if left untreated. Use of tocolytics (uterine relaxants), either alone or in combination with uterotonics, may be of value to minimise the need for manual removal of the placenta in theatre under anaesthesia.
Review CD#: 
CD007708
PEARLS No: 
332
Date: 
October, 2011
Authored by: 
Brian R McAvoy