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A very serious complication of childbirth is retained placenta in which the placenta does not separate from the inside wall of the uterus after an infant is born. Untreated, retained placenta can cause death from uncontrolled bleeding or infection. The conventional method of removing a retained placenta is 'manual removal' (by hand). This procedure is performed under anesthesia and can, itself, lead to serious consequences. The author describes a different approach which does not require manual methods and would eliminate the need for transportation to a specialized facility after delivery. The method relies on the injection of saline (a salt solution) into the umbilical vein, which carries blood within the umbilical cord from the placenta to the fetus during pregnancy. A smaller volume of saline can be used if the hormone oxytocin is given simultaneously; oxytocin causes uterine contractions, and enhances separation of the placenta. A review of the literature concerning the effectiveness of this method is presented. Placentas that remain in place for 15 to 30 minutes after delivery are generally considered 'retained'. Studies have found no apparent adverse effects of umbilical injection of oxytocin. However, manual removal of the placenta may become more difficult after the oxytocin injection. Although the injection of oxytocin into the umbilical vein appears to be a promising method for treating retained placenta, certain aspects of the procedure, such as the effect of the injection of fluid versus specific physiologic actions of the hormone, require further investigation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patients having had a cesarean delivery are now offered a trial of labor for a potential vaginal delivery at their next pregnancy, but this effort is generally stopped when labor fails to progress. In patients without a history of cesarean section labor can be induced artificially by administration of a synthetic form of the hormone oxytocin which is responsible for uterine muscle contractions during labor. However, caution has surrounded the use of oxytocin during a trial of labor because of the possibility of scar rupture, i.e., uterine rupture. Measurements of uterine activity were made before and after oxytocin induction in 63 women with cesarean uterine scars whose labors were progressing slowly (dysfunctional labor). Prior to administering oxytocin, the amplitude of uterine activity was lower than that found in other women who had cesarean scars but normally progressing labor. Twenty- two percent of the 63 patients ultimately required repeat cesarean section because of cephalopelvic disproportion (the mother's pelvis can not accommodate the size of the baby's head). These patients required longer durations and higher doses of oxytocin, their babies were larger by weight and the amount of cervical dilatation achieved was much less than the 78 per cent of patients who, after induction with oxytocin, had good labor progress as measured by cervical dilatation (cervical opening to accommodate the fetus). Researchers conclude that a favorable outcome can be predicted by effective cervical dilatation with satisfactory uterine activity when oxytocin is used for patients who have dysfunctional labor after a cesarean birth.