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Manual removal or spontaneous placental delivery and postcesarean endometritis and bleeding
Author(s) -
Dehbashi S,
Honarvar M,
Fardi F.H
Publication year - 2004
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/j.ijgo.2003.11.001
Subject(s) - medicine , endometritis , placenta , cesarean delivery , obstetrics , blood loss , pregnancy , gynecology , surgery , fetus , genetics , biology
Abstract 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.