DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20220884

Manual removal versus spontaneous delivery of the placenta at caesarean section: a randomized controlled trial

Laila Ezzat Abdelfattah, Abdullah Mohammed Abdullah Bastawy, Mohamed Salah El Deen Fahmy

Abstract


Background: Cesarean section (CS) is a life-saving surgery when certain complications occur during pregnancy and childbirth. The method of placental removing is one such procedure that can affect outcomes of cesarean delivery, such as the amount of bleeding during intraoperative and postoperative, the time of operation, the occurrence of postoperative endometritis, and may contribute to an increase or decrease in the incidence of CS. The objective of the study was to compare the manual removal of the placenta and spontaneous placental delivery at caesarean section.

Methods: One hundred twenty sex consented to participate and divided randomly into two groups: Group A: included 63 pregnant women underwent elective caesarean section, the placental left in situ and the uterus massaged waiting spontaneous placental separation and Group B: included 63 pregnant women underwent elective caesarean section in which placenta was removed manually.

Results: We found that women who had manual removal of the placenta lost significantly more blood than those who had spontaneous separation. A significant drop in hemoglobin was observed in manual separation group compared to spontaneous separation group. The median duration of placental delivery was shorter in manual separated group than spontaneously separated group. There was a statistically significant difference between both groups was found as regard the need for blood transfusion. There was a statistically significantly longer hospital stay with manual delivery of the placenta.

Conclusions: Spontaneous separation of the placenta during cesarean section is more beneficial than manual separation.


Keywords


Manual removal, Spontaneous delivery, Placenta, Caesarean section

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References


Murphy DJ, MacGregor H, Munishankar B, McLeod G. A randomised controlled trial of oxytocin 5IU and placebo infusion versus oxytocin 5IU and 30IU infusion for the control of blood loss at elective caesarean section--pilot study. ISRCTN 40302163. European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2009;142 (1):30-3.

Saccone G, Caissutti C, Ciardulli A, Barghella V. Uterine massage for preventing potpartum hemorrhage at cesarean delivery: Which evidence? Eu J Obstet Gynecol Rep Bio. 2018;152:509.

Newton ER, Prioda TJ, Gibbs RS. A clinical and microbiological analysis and risk factors or puerperal endometritis. Obstetrics & Gynecology. 2015;75:402-6.

Baskett TF, Arulkumaran S. Intrapartum care. London: RCOG Press. 2002;93:102.

Ramadani H. Cesarean section intraoperative blood loss and mode of placental separation. International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2004;87(2):114-8.

Vimala N, Mittal S, Kumar S. Sublingual misoprostol versus oxytocin infusion to reduce blood loss at cesar- ean section. Int J Gynaecol Obstet. 2006;92(2):106-10.

Anderson ER, Gates S. Techniques and materials for closure of the abdominal wall in caesarean section. Cochrane Database of Systematic Reviews. 2004;4(4):4663-6.

Cotter A, Ness A, Tolosa J. Prophylactic oxytocin for the third stage of labour. Cochrane Database of Systematic Reviews. 2001;4:26-36.

Baksu A, Kalan A, Ozkan A. The effect of placen tal removal method and site of uterine repair on post- cesarean endometritis and operative blood loss. Acta Obstet Gynecol Scand. 2005;84(3):266-9.

Dodd JM, Anderson ER, Gates S. Surgical techniques involving the uterus at the time of caesarean section. Cochrane Database of Systematic Reviews. Jurnal of Obestetrics and Gynecology. 2004;171(4):1022-5.

Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PloS One. 2016;11(2):0148343.

Schmidt LYS, Castro AFO, Siqueira JGL, Oliveira DP, Assis WRF. Pathophysiology of oncological pain: review of literature. Revista de Patologiado Tocantins. 2020;7(1):59-61.

Begley CM, Gyte GML, Murphy DJ. Active versus expectant management of women in the third stage of labour. Cochrane Database Syst Rev. 2011;11:CD007412.

Kamel A, El-Mazny A, Salah E, Ramadan W, Hussein AM, Hany A. Manual removal versus spontaneous delivery of the placenta at cesarean section in developing countries: a randomized controlled trial and review of literature. J Matern Fetal Neonatal Med. 2018;31(24):3308-13.

El-behiedy TM, Soliman BS, Ali FA, Ali MR. Spontaneous Separation Versus Manual Removal of Placenta During Elective Cesarean Section Regarding Blood Loss. The Egyptian Journal of Hospital Medicine. 2021;82(3):433-9.

Morales M, Boulvain M, Ceysens G, Jastrow. Spontaneous versus manual placental delivery during ceasarean section: a randomized controlled trial. American Journal of Obstetrics and Gynecology. 2004;187(6 pt 2):S58.

Gol M, Baloglu A, Aydin C, Ova L, Yensel U, Karci L. Does manual removal of the placenta affect operative blood loss during cesarean section? Eur J Obstet Gynecol Reprod Biol. 2004;112(1):57-60.

Chandra P, Schiavello HJ, Kluge JE and Holloway SL. Manualremoval of the placenta and postcesarean endometritis. J Reprod Med. 2002;47:101-6.