Sublingual nitroglycerin does not aid in the management of retained placenta

Takeaway

• The use of sublingual nitroglycerin does not aid in the management of retained placenta.

Why this matters

• Retained placenta after delivery affects 0.1%-2% deliveries and is associated with postpartum hemorrhage.

Key results

• There were no differences in time to delivery of placenta between the groups (12.1 vs 12.2 minutes; P=.60).
• More women received blood transfusion in the intervention group (11.4% vs 7.8%; P=.03).
• An equal number of women in both groups required manual removal of placenta in the operating room (73.9% of nitroglycerin vs 73% of controls; P=.74).

Study design

• The GOT-IT trial, a randomized, placebo-controlled, double-blind trial between 2014 and 2017 at 29 UK delivery units.
• Women with retained placenta following vaginal delivery were identified and enrolled.
• The intervention group (self-administered 2 puffs of sublingual nitroglycerin [800 μg]; n=543) was compared with a control group (placebo spray; n=564).
• Primary outcome was the need for manual removal of the placenta 15 minutes following intervention.
• Funding: UK National Institute for Health Research Health Technology Assessment Program.

Limitations

• Causes for retained placenta were not identified; different causes of retained placenta would theoretically affect response to nitroglycerin.