Manual removal of the placenta. Incidence and clinical significance.

OBJECTIVE

To determine the incidence and complications related to manual removal of the placenta.

METHODS

Review of hospital medical records from 1990 throughout 1994. One thousand five hundred and two vaginal deliveries from 1984 1992 were used for comparisons.

RESULTS

A total of 24,750 deliveries were registered during the five year study period. Placenta was removed manually in 165 women (0.6%). The use of general anesthesia for manual removal of placenta decreased from 74% in 1990 to 19% in 1994. Spinal analgesia was applied from 1993, and it was used in 42% of the women in 1994. Of 74 parous women, 12 (16%) had experienced retained placenta before. The average difference in the hemoglobin concentration between the prenatal and the postoperative values was 3.4 g/dl among the patients, and 10% required blood transfusion (1-4 units). Among the controls, there was no decrease in the average hemoglobin concentration, and only 0.5 needed blood transfusion. Endometritis following manual removal was detected in 1.8% of the patients and 1.5% among the controls. Despite manual removal, five women (3%) were considered to have retained placental fragments two days or later after delivery, which required curettage.

CONCLUSIONS

Placenta needed to be removed manually in 0.60% of all deliveries in our department. It was associated with increased incidence of hemorrhage and consequently low hemoglobin values. Women with a history of retained placenta have an increased risk of recurrence of retained placenta in subsequent deliveries.