Manejo de la retención placentaria basado en la evidencia científica actual

  1. Martínez Martín, Eduardo
  2. Martínez Galán, Paloma
  3. Manrique Tejedor, Javier
  4. Macarro Ruiz, Dolores
  5. Miguélez Llamazares, Lorena
Journal:
Metas de enfermería

ISSN: 1138-7262

Year of publication: 2013

Volume: 16

Issue: 6

Type: Article

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More publications in: Metas de enfermería

Abstract

Objective: to learn about the scientific evidence available on the care which should be provided by the Obstetric-Gynecologic Nurse Practitioner (matron) when faced with a case of placental retention. Method: narrative review where clinical trials and prospective and retrospective studies were analyzed, as well as bibliographic reviews, protocols, and clinical practice guidelines about the incidence of placental retention, factors with an impact on said incidence, diagnostic methods, associated complications, and its management. The databases­ searched were: PubMed, Uptodate, Cuiden, Cochrane Plus, Medline, Embase and Academic Google, using and combining the terms �postpartum haemorrhage�, �scientific evidence�, �uterotonics�, �birth�, �hemorragia postparto�, �evidencia científica� and �placental retention�. The search included the years between 1990 and 2012, and the languages of choice were English and Spanish. Results and conclusions: the incidence of placental retention varies according to population, representing between 0.5 and 3% of all vaginal births, and it can be diagnosed by observing the lack of signs of placental expulsion. When the placenta is attached, manual extraction is the type of treatment with higher success rate, but there are less invasive measures, such as the injection of prostagladins, oxitocyn or plasma- expanding drugs into the umbilical vein. An oxitocyn injection in the umbilical vein within 15-20 minutes post-partum reduces the incidence of manual extraction. Sublingual nitroglycerin showed a clear benefit in terms of reduction of the need to extract the placenta manually. There are no studies with sufficient scientific evidence to support the use of plasma-expanding drugs and prostagladins. Placental retention is an emergency which may occur in the delivery room, and may be occasionally fatal. Therefore, matrons must be aware of the recommendations based on the best available scientific evidence, where an active management of birth is recommended, as it is associated with a reduction in the risk of postpartum hemorrhage (PPH).

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