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Cesarean section intraoperative blood loss and mode of placental separation
Author(s) -
Ramadani 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.2004.07.019
Subject(s) - medicine , placenta , hemoglobin , blood loss , blood transfusion , prospective cohort study , anesthesia , cesarean delivery , retained placenta , significant difference , surgery , obstetrics , pregnancy , fetus , genetics , biology
Objective To investigate whether manual removal of the placenta is associated with significant blood loss compared with spontaneous separation of the placenta during cesarean delivery. Design A randomized prospective study of 400 women with normal pregnancies undergoing cesarean delivery at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Patients were randomly assigned to the study group, (manual placental removal, n =200) or the control group (spontaneous placental separation, n =200). Operative blood loss was assessed by the volumetric and gravimetric methods. Hemoglobin levels were evaluated the third postoperative day and patient's postoperative complications were recorded. Results The mean±S.D. amount of blood loss associated with manual and spontaneous removal of the placenta was 713±240 and 669±253 ml, respectively. This difference was statistically significant ( P =0.04). There was a postoperative decrease in hemoglobin levels in both groups. Preoperative hemoglobin levels were 11.6±3 g/dl in the study group and 11.2±1.1 g/dl in the control group, and the difference was statistically significant ( P =0.006). The postoperative hemoglobin levels at day 3 were 9.0±1.2 g/dl in the study group and 9.9±1.2 g/dl in the control group ( P =0.003), also a statistically significant difference. The incidence of endometritis, wound infection, and need for blood transfusion was similar in the two groups. Conclusion Manual delivery of the placenta was significantly associated with greater operative blood loss and greater decrease in postoperative hemoglobin levels, but with shorter operative time compared with spontaneous placental separation. No difference in postoperative complications was noted between the groups.