Optimization of third-stage management after second-trimester medical pregancy termination

OBJECTIVE: Comparison of 3 regimens for third-stage management after second-trimester intravaginal misoprostol termination STUDY DESIGN: Prospective randomized trial Three third-stage management strategies were compared 10 units of intramuscular oxytocin (group 1), 600 mu g oral misoprostol (group 2), or no additional medication (group 3) after fetal expulsion Primary study outcome was the incidence of placental retention RESULTS: Two hundred fifty-one women were randomly assigned to the groups. There was a significant difference in placental retention rates. group 1, 8 of 83 (10%) vs group 2, 24 of 83 (29%) vs group 3, 26 of 85 (31%); P = 002 Blood loss was significantly lower in group 1, 100 mL (interquartile ranges, 50-200) vs group 2, 200 mL (interquartile ranges, 100-370) vs group 3, 200 mL (interquartile ranges, 100-375), P < .001. Requirment for blood transfusion group 1, 1 of 83 (1%) vs group 2, 1 of 83 (1%) vs group 3, 5 of 85 (6%); P = .103 CONCLUSION: Intramuscular oxytocin administered after fetal delivery after second-trimester medical termination significantly increases placental expulsion rates and decreases short-term postpartum blood loss