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PL.85 Umbilical Vein Injection in the Management of Retained Placenta-Closing the Audit Loop
  1. S Sim,
  2. W Ogunnoiki
  1. Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK

Abstract

Background NICE intrapartum guidelines introduced in 2007 recommended use of umbilical vein Oxytocin injection for management of retained placenta and discredited the use of intravenous Oxytocin infusion (with the exception of its association with postpartum haemorrhage). A local audit in 2009 assessing practise of management of retained placenta revealed high rates of intravenous Oxytocin use and lower rates of intra-umbilical Oxytocin injection. This led to the introduction of local guidelines unified with NICE in 2012. We present the finding of re-audit to assess adherence to local guidelines in particular to the use of Oxytocin in the management of retained placenta.

Method The retrospective audit was carried out between 1 May 2012 and 31 August 2012 with 33 cases identified. Data was collected on patient demographics, rates of intravenous and umbilical vein Oxytocin injection use, amongst other parameters.

Results There was a reduction in use of intravenous Oxytocin infusion from 57% to 15% suggesting improved adherence to NICE guidance, but interestingly also showed a reduction in use of umbilical vein injection Oxytocin from 28% to 18%.

Conclusion This reduction in use of umbilical vein injection can be postulated to be due to the lack of robust evidence supporting this intervention. This is consistent with recent Cochrane review in 2011 that showed a non-statistically significant rate reduction of MROP with umbilical vein injection of Oxytocin. Additionally, newer WHO guidelines introduced in 2012 no longer advocate use of umbilical vein Oxytocin injection as first-line intervention for retained placenta.

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