A retained placenta (RP) is a complication after a normal birth, which affects nearly 11,000 women in the UK a year. The recommended treatment for RP is a surgical procedure - manual removal of placenta (MROP). This is a painful and unpleasant procedure for the women, involving an additional stay in hospital, and is an additional cost for the NHS.
GOT-IT was a multi-centre randomised controlled blinded trial, funded by the NIHR HTA Programme, investigating whether treatment with oral Glyceryl trinitrate (GTN) is an effective treatment for retained placenta which will lead to a reduction in the number of women requiring manual removal of the placenta. Women with retained placenta were randomised to either GTN or placebo.
The trial randomised 1107 women from 29 UK obstetric units. The study concluded that GTN did not increase delivery of retained placenta within 15 minutes of administration. The study also found there was no difference in blood loss between GTN and the placebo group, GTN had increased side effects and was not cost-effective.
The trial was led by Dr Fiona Dennison based at the University of Edinburgh.
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Denison FC, Carruthers KF, Hudson J, McPherson G, Scotland G, Brook-Smith S, et al. Glyceryl trinitrate to reduce the need for manual removal of retained placenta following vaginal delivery: the GOT-IT RCT. Health Technol Assess 2020;23(70)
Denison FC, Carruthers KF, Hudson J, McPherson G, Chua GN, et al. (2019) Nitroglycerin for treatment of retained placenta: A randomised, placebo-controlled, multicentre, double-blind trial in the UK. PLOS Medicine 16(12): e1003001. https://doi.org/10.1371/journal.pmed.1003001
Denison FC, Norrie J, Lawton J, et al. A pragmatic group sequential, placebo-controlled, randomised trial to determine the effectiveness of glyceryl trinitrate for retained placenta (GOT-IT): a study protocol. BMJ Open 2017;7:e017134. doi: 10.1136/bmjopen-2017-017134 https://bmjopen.bmj.com/content/bmjopen/7/9/e017134.full.pdf