This study evaluates intra umbilical vein injection of 800 µg versus 400 µg misoprostol for the treatment of retained placenta to reduce the need of manual removal of placenta under general anaesthesia

The third stage of labor may be complicated by retained placenta, which may cause severe bleeding and infection, with a potentially fatal outcome. Manual removal of placenta is the current standard of management of retained placenta which usually requires general or regional anaesthesia at a hospital and it is an invasive procedure that may lead to bleeding, trauma and infection. Intraumbilical injection of uterotonic agent( misoprostol) is an easy, non invasive procedure. A randomized clinical trial are required to determine the difference between two doses of misoprostol 400 versus 800 micro gram for management of retained placenta

Inclusion Criteria:

• women with a singleton pregnancy, delivered vaginally
• 28 weeks of gestation and more,
• had a prolonged third stage of labor (more than 30 minutes) despite active management,
• Haemodynamically stable and accept to participate in the trial

Exclusion Criteria:

• multiple pregnancies,
• previous caesarean delivery,
• haemodynamically instability, severe anaemia (haemoglobin concentration <8 g/dL),
• chorioamnionitis
• Refused to participate in the trial