Manual removal or spontaneous placental delivery and postcesarean endometritis and bleeding.

OBJECTIVES

To compare the effect of manual removal and spontaneous delivery of placenta on postcesarean bleeding and endometritis.

METHODS

In this prospective study 400 pregnant women undergoing elective cesarean delivery were randomly assigned to two groups: spontaneous placental delivery (200 women) and manual placental delivery (200). No antibiotic prophylaxis was administered in either group. The significance of blood loss due to cesarean delivery was defined by a drop in hemoglobin concentration of more than 1 g/dl 24 h after delivery in comparison with preoperative hemoglobin concentration. Endometritis was diagnosed in patients who developed clinical signs of fever and suprapubic tenderness 48 h after delivery. We analyzed the data using a t-test.

RESULTS

The overall endometritis rate was 27%, in 40 women in the spontaneous placental delivery group (20%) and 68 women in the manual placental removal group (34%). There was a statistically significant difference between the two groups (P=0.001). Significant blood loss was experienced by 52 women (26%) in the spontaneous placental delivery group vs. 100 women (50%) in the manual placental delivery group. There was a statistically significant difference in blood loss between the two groups (P=0.000; RR=1.92).

CONCLUSION

Endometritis and blood loss in cesarean delivery is increased by manual removal of the placenta compared with the spontaneous method of placental removal.