Hindawi Publishing Corporation Obstetrics and Gynecology International Volume 2012, Article ID 321207, 6 pages doi:10.1155/2012/321207 Clinical Study Nitroglycerin for Management of Retained Placenta: A Multicenter Study Maria Bullarbo,1 Hans Bokstro¨m,2 Ha˚kan Lilja,2 Elisabeth Almstro¨m,3 Nina Lassenius,4 Agneta Hansson,5 and Erling Ekerhovd2, 6 1 Department of Obstetrics and Gynecology, So¨dra A¨lvsborg Hospital, 501 82 Bora˚s, Sweden 2 Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden 3 Department of Obstetrics and Gynecology, NA¨L Hospital, 461 85 Trollha¨ttan, Sweden 4 Department of Obstetrics and Gynecology, Vrinnevi Hospital, 603 79 Norrko¨ping, Sweden 5 Department of Obstetrics and Gynecology, Central Hospital of Karlstad, 651 85 Karlstad, Sweden 6 Fertility Clinic Sør, Telemark Hospital, 3901 Porsgrunn, Norway Correspondence should be addressed to Maria Bullarbo, maria.bullarbo@vgregion.se Received 31 January 2012; Revised 21 March 2012; Accepted 22 March 2012 Academic Editor: Russell K. Laros Jr. Copyright © 2012 Maria Bullarbo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The primary aim was to determine if sequential administration of oxytocin and nitroglycerin is eﬀective for management of retained placenta when performed by obstetricians with no experience of the method. Secondary aims were to examine possible adverse eﬀects of nitroglycerin. One hundred and ﬁve women with retained placenta were randomly selected to receive either 1 mg nitroglycerin or placebo tablets sublingually if intravenous oxytocin had failed to expel the placenta. At two of the hospitals some of the midwives were familiar with the use of nitroglycerin. The other midwives and all the participating obstetricians had no clinical experience of the method. In the treatment group, detachment of placenta following nitroglycerin occurred in 37.3% of the women compared to 20.4% in the placebo group (P = 0.056). In the two hospitals with some experience of the method, placenta was removed in 9 of 19 (47.4%) women in the nitroglycerin group compared to 3 of 17 (15.0%) women in the placebo group. No adverse eﬀects of clinical importance were registered. Although the diﬀerence between the two groups did not reach statistical signiﬁcance, the higher success rate in the two hospitals with some experience could indicate that clinical experience is of importance in order to achieve placental detachment. 1. Introduction Retained placenta complicates up to 2.0–3.3% of all vaginal deliveries [1, 2]. The most common cause of retained placenta has been shown to be a failure of retroplacental myometrial contractions [3]. Without immediate treatment, women are at high risk of hemorrhage. The delivery of oxytocin to the retroplacental myometrium via the umbilical vein or intravenously is often applied to induce myome- trial contractions and placental detachment. The WHO guidelines for management of postpartum hemorrhage and retained placenta recommend injection of saline-diluted oxytocin into the umbilical vein [4]. However, a recently published large randomized study concluded that this method has no clinically signiﬁcant eﬀect [5]. Thus, manual removal of the placenta under general or regional anesthesia is usually needed. Alternatively, when oxytocin fails, it has been shown that the sequential administration of oxytocin and sublingual nitroglycerin is eﬃcient for the management of retained placenta [6, 7]. Nitroglycerin relaxes smooth muscle cells by releasing nitric oxide and is regularly used to induce prompt uterine relaxation in cases of obstetric emergency [8]. A recent Cochrane review concluded that sublingual nitroglycerin seems to both reduce the need for manual removal of placenta and blood loss during the third stage of labour when compared to placebo [9]. However, it was also emphasized that further trials are needed to conﬁrm its clinical role and safety. A very high success rate for management of retained placenta was reported following sequential administration of