SEARCH · PubMed Health

Results for “Placenta, Retained”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 253 records · Page 14Linked to original sources

PubMed2001

A randomized controlled trial comparing oxytocin administration before and after placental delivery in the prevention of postpartum hemorrhage.

OBJECTIVE: To determine if the timing of the administration of prophylactic oxytocin influences the incidence of postpartum hemorrhage caused by uterine atony, retained placenta, and third-stage duration. STUDY DESIGN: Parturients who presented for vaginal delivery were randomized in a double-blinded fashion to receive oxytocin, 20 units in a 500-mL crystalloid intravenous bolus, beginning upon delivery of either the fetal anterior shoulder or placenta. For all patients, the third stage of labor was managed with controlled cord traction until placental expulsion, followed by at least 15 seconds of fundal massage. Patients were excluded if they had a previous cesarean section, multiple gestation, antepartum hemorrhage, or bleeding disorder. RESULTS: A total of 1486 patients were enrolled: 745 in the before-placenta group and 741 in the after-placenta group. The groups were similar with respect to gestational age, fetal weight, labor duration, maternal age, parity, and ethnicity. The incidence of postpartum hemorrhage did not differ significantly between the two groups (5.4% vs 5.8%; crude OR, 0.92; 95% CI, 0.59 to 1.43). There were no significant differences between the two groups with respect to incidence of retained placenta (2.4% vs 1.6%; OR, 1.49; 95% CI, 0.72 to 3.08), or third-stage duration (7.7 minutes vs 8.1 minutes; P =.23). CONCLUSIONS: The administration of prophylactic oxytocin before placental delivery does not reduce the incidence of postpartum hemorrhage or third-stage duration, when compared with giving oxytocin after placental delivery. Early administration, however, does not increase the incidence of retained placenta.

Adolescent↗

PubMed2002

Prepartum monensin for the reduction of energy associated disease in postpartum dairy cows.

A total of 1317 Holstein cows from 45 farms in the Canadian provinces of Quebec, Prince Edward Island (PEI) and Ontario were enrolled in a randomized trial during 1998 and 1999 to further confirm the efficacy of a monensin controlled release capsule in preventing periparturient disease in lactating dairy cows. Cows were randomized on the farms to receive either a monensin controlled release capsule (CRC) 2 to 4 wk before expected calving or to serve as negative controls. Health data were collected for 90 d postcalving and were analyzed with logistic regression accounting for the intraherd correlation with generalized estimating equations. Monensin CRC significantly reduced the incidence of both clinical ketosis and abomasal displacement post-calving. There was a numerical but nonsignificant decrease in the incidence of retained placenta in cows receiving a monensin CRC. A pooled analysis of two separate but similar studies (conducted in 1995 and 1998) demonstrated a strengthened association between monensin CRC administration precalving and reduced periparturient disease. A 40% reduction in both abomasal displacement and clinical ketosis was observed with precalving administration of a monensin CRC. In addition, the larger dataset highlighted a trend for a 25% reduction in the incidence of retained placenta in monensin-treated cows. Improved energy metabolism as a result of monensin treatment is likely the mechanism for the reduction in incidence of all three of these diseases. Thus the term "energy associated disease" was created to assess the combined impact of the precalving monensin treatment on the incidence of retained placenta, displaced abomasum, and clinical ketosis. The monensin controlled release capsule reduced the incidence of energy associated disease by 30%.

Abomasum↗

PubMed1996

[The effect of subclinical and acute ante partum acidosis in cows on the course of pregnancy with regard to the steroid hormone profile].

Experiment 1: In a field experiment in 19 of 87 cows being in day 260-265 of pregnancy subclinical metabolic acidosis was found. The control group included 10 healthy cows in the same stage of pregnancy. Blood samples from cows of both groups were collected once daily until day 2 post partum for determination of oestrogens, progesterone and cortisol. Dystocia was found in four and retained placenta in three cows having acidosis. These cows had lower oestrogens and markedly higher cortisol and progesterone concentrations during parturition. Course of pregnancy and delivery in control cows an without any difficulties and hormonal profiles in these cows were typical. Experiment 2: On day 265 of pregnancy experimental acute acidosis was evoked in five cows and five other cows served as control. Sampling of blood was the same as in experiment 1. Acidosis caused on day 269 in two cows premature birth with retained placenta. Moreover concentrations of studied steroids were atypical. In three other cows with acidosis course of pregnancy and delivery was without any trouble. Only cortisol was increased while progesterone and oestrogen values were in agreement with concentrations of control cows. Data suggest that metabolic acidosis can cause dystocia, premature birth and retained placenta. Furthermore, acidosis clearly affects the profile of steroid hormones.

Acid-Base Equilibrium↗

PubMed2001

Calf survival from embryo transfer-induced twinning in dairy-beef cows and the effects of synchronised calving.

In each of 4 years, 94-116 mature cows had two 6-7-day-old embryos, produced by the in vitro fertilisation of oocytes, inserted non-surgically into one uterine horn of each cow. Starting 5 days before the expected date of calving, the cows were continuously observed and assistance at calving was provided when required. In year 1, perinatal calf survival was similar in twin-calving (TC) and single-calving (SC) cows (98.1 versus 100% for calves born to TC and SC, respectively). There was a higher incidence of assistance at birth for TC (52%) than for SC (21%). In years 2 and 3, the calving of 30 SC and 33 TC was synchronised using an injection of Opticortinol (OP) 6-9 days before the injection of Estrumate and Dexol-5 (E+D). A further 34 SC calved naturally. Synchronised calving reduced the spread of calving from 16-25 to 8-9 days without reducing perinatal calf survival and had no significant effect on the incidence of assistance at birth in SC. The TC in years 2 and 3 had a high incidence of retained placenta at 48 h (70%) and a high incidence of assistance at birth (85%). In year 4, calving was synchronised in 16 SC and 21 TC with E+D and no pre-treatment with OP, while 15 SC were treated with both OP and E+D. There were no effects of the hormone treatment on perinatal calf survival and only small effects on the incidence of assisted births for SC. The incidence of retained placenta at 48 h was lower for SC pre-treated with OP (40%) than for SC (88%) and TC (76%) not pre-treated with OP. Continuous supervision over calving produced perinatal calf survival rates for TC that were similar to SC, despite the higher incidence of assistance of TC at parturition. Hormonal synchronisation of calving can halve the time required for continuous supervision of calving, but the hormone treatments exacerbate the already high incidence of retained placenta in TC.

Adrenal Cortex Hormones↗

PubMed2001

Manual removal of the placenta--a case control study.

The aim of this study was to determine the incidence and complications related to manual removal of the placenta in a regional hospital in Australia. The study was carried out at the Goulburn Valley Base Hospital in Shepparton. The hospital medical records were reviewed from 1992 to 1999. A total of 3734 singleton live vaginal deliveries took place during the 7-year study period. The placenta was removed manually in 114 women (3%). For a control group, a series of 113 women who had singleton live vaginal deliveries from the same period were chosen at random. The case and control groups were similar in age, parity, and gravidity. A previous history of retained placenta and a history of preterm delivery in the current pregnancy were significantly related to retained placenta (OR 9.8 [95% CI 1.1-85.5] and OR 5.6 [95% CI 1.1-26.8], respectively). The cases received significantly more blood transfusions than the control group (13% versus 0%). Decreased maternal age was also significantly related to retained placenta. There were also more post-delivery dilatation and curettage (D&C) operations and diagnosis of endomyometritis in the case group. However, these differences were not statistically significant. One woman, in the case group, had to have a hysterectomy due to placenta accreta.

Adult↗

PubMedDate not supplied

Natural history of twin gestation complicated by in utero fetal demise: associations of chorionicity, prematurity, and maternal morbidity.

OBJECTIVES: To evaluate the pathophysiology by which the in utero death of 1 twin might increase morbidity to its co-twin survivor and its mother. To assess previously reported risks for maternal disseminated intravascular coagulopathy, peripartal hemorrhage, retained placenta and infection, as well as the fetal risk of prematurity. MATERIAL AND METHODS: A retrospective analysis of the natural history of twin pregnancies from three institutions was performed. A total of 1,989 cases of twin pregnancy were identified, Wayne State University included 1,266 cases from 1984 to 1993; Madigan Army Medical Center 136 cases, 1995-2000, and Rockford Regional Perinatal Center, 587 cases, 1990-2000. The findings were classified by the presence or absence of fetal death in utero (IUFD) as follows: both IUFD (0/0); 1 IUFD (0/+), and both live born (+/+). A case-control study was performed on the subgroup of patients for whom complete records as to chorionicity, etc., were available. RESULTS: Of the 1,989 cases reviewed there were 49 both IUFD (0/0), 61 complicated by 1 IUFD (0/+), and 1,879 with both live born (+/+). The overall fetal death rate for this twin cohort was 55/1,000. IUFD of 1 or both twins was related to an increased risk of previable delivery 55% in 0/0, and 28% in 0/+ versus 4% for +/+ with p<0.001. IUFD also was associated with early preterm delivery (mean gestational age at delivery of 23 (0/0) and 30 (0/+) versus 35 (+/+) weeks). Chorionicity as well as maternal risks were examined in the case-control study (24 (0/0), 43 (0/+), 134 (+/+)) with the following results: monochorionic placentation was more likely in pregnancies complicated by IUFD (54% (0/0), 51% (0/+) versus 14% (+/+); p<0.001). Retained placenta, requiring dilation and curettage, occurred more frequently when both twins died in utero, but may be related to the earlier gestational age at delivery. DISCUSSION: Independent of retained placenta, there is no difference in the maternal risks for hemorrhage, abruption, coagulopathy or infection between groups. Immaturity at delivery and monochorionicity are more common in pregnancies complicated by fetal demise. Neonatal morbidity and developmental outcome will be the focus of a longitudinal study comparing cotwin survivors to twins matched for chorionicity and gestational age at delivery.

Case-Control Studies↗

PubMed1997

Controlled cord traction versus minimal intervention techniques in delivery of the placenta: a randomized controlled trial.

OBJECTIVES: Our purpose was to compare the controlled cord traction technique with the minimal intervention technique for delivery of the placenta. The primary outcome was the incidence of postpartum hemorrhage. Secondary outcomes included duration of third stage of labor, frequency of retained placenta, hemorrhagic shock, the need for blood transfusion, and the need for uterotonic agents to control postpartum hemorrhage. STUDY DESIGN: A total of 1648 women who were delivered vaginally were randomly allocated during labor to the controlled cord traction group (n = 827) or the minimal intervention group (n = 821). In the controlled cord traction group women received oxytocin, 10 units intramuscularly, with delivery of the baby's anterior shoulder, after which the placenta was delivered actively by controlled cord traction (Brandt-Andrews method). In the minimal intervention group the placenta was delivered by maternal pushing. Continuous intravenous oxytocin was given after delivery of the placenta. Odds ratios with 95% confidence intervals were calculated for each variable. RESULTS: The overall incidence of postpartum hemorrhage was significantly lower in the controlled cord traction group (5.8% vs 11%; odds ratio 0.50, 95% confidence interval 0.34 to 0.73). The incidence of retained placenta (> or = 30 minutes) was 1.6% in the controlled cord traction group and 4.5% in the minimal intervention group (odds ratio 0.31, 95% confidence interval 0.15 to 0.63). Significantly more patients in the minimal intervention group required additional uterotonic agents to control hemorrhage (5.1% vs 2.3%; odds ratio 0.44, 95% confidence interval 0.24 to 0.78). CONCLUSION: The controlled cord traction technique for delivery of the placenta results in a significantly lower incidence of postpartum hemorrhage and retained placenta, as well as less need for uterotonic agents, compared with the minimal intervention technique.

Delivery, Obstetric↗

PubMed1993

Puerperal CRP-levels after manual removal of the placenta.

Maternal serum C-reactive protein (CRP) values were determined daily during the postpartum period in 113 cases after manual removal of a totally retained placenta. 200 mothers with uncomplicated pregnancy and delivery served as controls. The mean CRP-level in the study group was significantly higher than in the control group on the first postpartum day, 47.17 mg/L (SD 31.62) vs 39.00 mg/L (SD 28.00) and on the second day, 53.06 mg/L (SD 33.95) vs 42.00 mg/L (SD 21.00), reaching similar levels on the third day. The increase of CRP-values on the second day was 12% in the retained placenta group and 7% in the control group. There was no correlation between CRP-values and body temperature, white blood cell count or erythrocyte sedimentation rate, but the CRP-level was lower after excessive blood loss and increased after blood transfusion. Being a marker of infection and tissue damage, the maternal CRP-level on the first and second postpartum day primarily reflects the events of parturition. CRP-levels are higher after manual removal of a totally retained placenta without an obvious explanation for this phenomenon, and this has to be taken into account when CRP is used for diagnosing postpartum infections.

Adolescent↗

PubMed1995

The effects of induced parturition on the incidence of clinical disease and mortality in dairy cows from commercial herds in south-western Victoria.

The effects of induced parturition on clinical disease and mortality of cows were studied in 51 winter-calving, pasture-fed, dairy herds in south-western Victoria. Parturition was induced when most cows were between 27 and 35 weeks of pregnancy. Control groups were selected from herdmates that were not induced to calve. The incidence of retained placenta was much greater among induced cows of all ages. The proportion of cows affected by any clinical disease other than retained placenta, and the incidence of mortality were much greater after induction among cows aged over 6 years but not among cows aged 3 to 6 years.

Age Factors↗

PubMed1984

Factors responsible for post parturient metritis in dairy cattle.

Factors associated with retained placenta and post parturient metritis in Israeli-Friesian dairy cattle are examined. The overall incidence rate, in a total of 2017 calvings on seven farms, was 16.1 per cent for retained placenta and 37.3 per cent for primary metritis. Risk factors associated with retained placenta include rising parity, short gestations, induction of parturition, multiple births, summer calvings, left displacement of the abomasum and ketosis. Risk factors associated with metritis include declining parity, long gestations, induction of parturition, stillbirth, multiple births, low milk yield before drying off, left displacement of the abomasum, ketosis and winter calvings. A proposed aetiology of metritis is presented and the various possible factors involved are discussed.

Animals↗

PubMed1993

Delayed postpartum hemorrhage: a morphologic study of causes and their relation to other pregnancy disorders.

OBJECTIVES: To ascertain the various causes of delayed postpartum hemorrhage and to test whether subinvolution of the placental bed is associated with other pregnancy disorders for which defective maternal-fetal interaction has been implicated pathogenetically. METHODS: In a group of women presenting with postpartum hemorrhage following singleton pregnancies, tissue that had been submitted for histopathologic examination was reviewed morphologically to delineate the various causes of delayed postpartum hemorrhage. The stratified groups were analyzed for relationship to preeclampsia, fetal growth retardation (FGR), spontaneous abortion, placenta accreta, and retained placental fragments in previous pregnancies. Odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated for each association. RESULTS: One hundred sixty-nine cases were identified. Tissue obtained at curettage or, rarely, at hysterectomy could be categorized into seven pathologic groups: involution of the placental bed, subinvolution of the placental bed, retained placental fragments, endometritis, normal endometrium, normal decidua, or nondiagnostic tissue. Hyalinized fragments of uteroplacental (spiral) arteries that were either collapsed or completely thrombosed were seen in involution of the placental bed. Subinvolution of the placental bed was characterized by widely distended and patent residua of uteroplacental arteries with only partial occlusion by thrombosis. Women with retained placental fragments (OR 3.93, 95% CI 1.51-10.47), but not women with an involuted placental bed (OR 2.40, 95% CI 0.68-8.54) or subinvolution of the placental bed (OR 1.52, 95% CI 0.51-4.57), had increased incidences of preeclampsia, FGR, spontaneous abortion, or retained placenta in previous pregnancies when compared to women with endometritis, endometrium only, decidua only, or nondiagnostic tissue. CONCLUSION: Retained placental fragments, reflecting placenta accreta, and subinvolution of the placental bed are important causes of delayed postpartum hemorrhage. The former is associated with an increased incidence, in prior pregnancies, of pregnancy complications that probably reflect aberrant maternal-trophoblastic interaction.

Arteries↗

PubMed1996

Activity of placental glutathione peroxidase and superoxide dismutase in cows with and without retained fetal membranes.

Changes in the levels of the activity of two enzymes that neutralize free radicals-glutathione peroxidase [(EC.1.11.1.9), GSH-Px] and superoxide dismutase--[(EC.1.15.1.1), SOD]--in cows with fetal membranes retention (RFM) were studied. The activities were measured in maternal and fetal placental tissues after spontaneous parturition without (group A) and with (group B) retained placenta. GSH-Px activities were higher in group B than in group A (P < 0.05). The activity of this enzyme was lower in the maternal than in the fetal part of the placenta in both groups. The activity of SOD was significantly (P < 0.05) lower in maternal part, and higher in fetal part, of placenta in group B compared with group A. Experiments on defence mechanisms against free radicals in periparturient cows in connection with more frequent sampling, prostaglandins levels, oxidative stress, nutrition and retained placenta are required to further elucidate the role of these enzymes.

Animals↗

PubMed1993

Risk factors for major obstetric haemorrhage.

The factors associated with major obstetric haemorrhage were analyzed using data relating to 37,497 women delivered in 1988 in National Health Service maternity units in the North West Thames Region, UK. Four hundred ninety-eight cases (1.33%) were complicated by haemorrhage of 1000 ml or more. Intrinsic factors associated with significant risk ratios (99% confidence intervals) included placental abruption 12.6 (7.61-20.9), placenta praevia 13.1 (7.47-23.0), multiple pregnancy 4.46 (3.01-6.61) and obesity 1.64 (1.24-2.17), but not high parity. Significant risk factors related to obstetric management and delivery included retained placenta 5.15 (3.36-7.87), induced labour 2.22 (1.67-2.96), episiotomy 2.06 (1.36-3.11) and birthweight 4 kg or more 1.90 (1.38 to 2.60). Among the 59 women who lost 1000 ml or more in association with a spontaneous vaginal delivery with an intact perineum, significant risk ratios (99% confidence intervals) were retained placenta 13.7 (5.92-31.8) and induced labour 2.35 (1.11-4.98). These data provide a more comprehensive assessment of risk factors for potentially life threatening haemorrhage in British obstetric practice than is possible using maternal mortality statistics. The hazards of well known factors such as multiple pregnancy, abruption, placenta praevia and caesarean delivery were confirmed but attention is drawn to the potential risk of haemorrhage associated with obesity or a large baby and to that associated with retained placenta in women classified as 'low risk'.

Adult↗

PubMed1994

[Markers of nutritional risk for placental retention: use of blood analysis at the end of gestation].

A sample of 1,225 calvings was used to detect predictors for retained placenta before parturition: 300 with retention, 925 without. Biochemical analyses showed an increased energy mobilization, hypocalcemia, and lower levels of circulating amino acids and monocytes within the last 2 weeks of gestation in cows with a retained placenta. The results agree with the reported smaller quantity of concentrates supplied to these cows before parturition. More cows with retained placenta were fed cereals but received less phosphorus with the mineral supplementation.

Amino Acids↗

PubMed2005

A randomized trial comparing oral misoprostol with intra-amniotic prostaglandin F2alpha for second trimester terminations.

OBJECTIVE: To compare the efficacy of oral misoprostol with that of intra-amniotic prostaglandin F2alpha (PGF2alpha) for second trimester pregnancy termination. METHODS: One hundred seventeen women with pregnancies of between 16 and 22 weeks' gestation were randomly assigned after insertion of laminaria to receive either oral misoprostol 400 microg every 4 hours (to a maximum of four doses) or intra-amniotic PGF2alpha 40 mg. The rate of complete abortion within 24 hours was the primary outcome for power analysis. Secondary outcome measures were the rate of dilatation and curettage (D&C) for retained placenta and the rates of fever and gastrointestinal complications. RESULTS: Patient characteristics were similar in both groups. The rate of complete abortion within 24 hours was similar in the misoprostol (63%) and PGF2alpha (66%) groups. The rate of retained placenta requiring D&C was significantly greater in the PGF2alpha group (22.4% vs. 3.4%, P = 0.002). There were no differences in other maternal morbidities. Parous patients treated with oral misoprostol had a significantly greater rate of complete abortion than nulliparous patients (84% vs. 57%, P = 0.04). CONCLUSIONS: Oral misoprostol is as effective as intra-amniotic PGF2alpha for second trimester pregnancy termination when laminaria is inserted before treatment. Parous patients have a higher success rate than nulliparous patients with use of oral misoprostol. Oral misoprostol is associated with a very low rate of placental retention.

Abortifacient Agents, Nonsteroidal↗

PubMed2000

Recurrent sacculation of the pregnant uterus. A case report.

BACKGROUND: Recurrent uterine sacculation is very rare and associated only with pregnancy. It commonly complicates delivery with a retained placenta. CASE: A 24-year-old woman, gravida 4, para 0, with three previous elective abortions, presented in preterm labor at 32 6/7 weeks' gestation. Her second and third abortions were complicated by incomplete evacuation of uterine contents, and uterine sacculation was diagnosed. Preterm delivery and a retained placenta complicated the present pregnancy. At laparotomy, recurrence of uterine sacculation was noted in the left fundal region of a bicornuate uterus. A hysterotomy was performed to remove the placenta from the sacculation. CONCLUSION: In a patient with multiple uterine procedures and retained placenta, uterine sacculation can develop.

Adult↗

PubMed1984

Vitamin E and selenium for reproduction of the dairy cow.

Selenium injections and oral vitamin E supplementation prepartum were related to incidence of retained placenta, metritis, and cystic ovaries in a 2 X 2 factorial experiment. Groups were: 1) selenium and vitamin E, 2) vitamin E, 3) selenium, and 4) control. Incidence of retained placenta was 17.5% in cows of groups 2, 3, and 4, whereas it was reduced to 0% in cows receiving both selenium and vitamin E. Incidence of metritis was 60% for cows injected with selenium and 84% for those not receiving selenium. Cystic ovaries were diagnosed in 19% of cows injected with selenium, and incidence was 47% for cows not treated with selenium. Supplementation of vitamin E was required in addition to selenium for prevention of retained placenta of cows fed stored ensiled forage, and prepartum selenium injections were effective for reducing the incidence of metritis and cystic ovaries during the early postpartum period.

Animals↗

PubMed1996

The association between cumulative milk yield, days open, and days to first breeding in New York Holstein cows.

The associations among milk yield, days open, and days to first breeding were studied in 15,320 Holstein cows, calving between June 1990 and November 1993, in 26 New York herds. Survival analysis, incorporating the Cox proportional hazards model, was used to quantify the effect of milk yield and other covariables on days open and days to first breeding. Sensitivity analysis was also performed. Sixty-day cumulative individual milk yield, calving season, parity, and herd were included in all models. Several diseases and their lactational risk also were studied as potential confounders: retained placenta (5%), milk fever (1%), ketosis (3%), metritis (6%), abomasal disorder (5%), mastitis (5%), and cystic ovary (3%). Cows yielding milk in the highest quintile had a slightly lower conception rate than did cows yielding milk in the lowest quintile. Conception rate varied with parity and season. Retained placenta, metritis, and cystic ovary lowered the conception rate. High yielding cows were more likely to be inseminated than were low yielding cows. Older cows and those with metritis, mastitis, and cystic ovary had lower rates on insemination. These results indicate that conception and insemination might be influenced by factors related to management (e.g., culling) and to the cow (e.g., disease history) but that increased milk yield plays a very minor role.

Animals↗