Influence of placental removal method on the incidence of post-cesarean infections and operation duration

Postpartum endometritis is 1-8% and cesarean section is one of its risk factor. The present study was performed to compare the effect of manual removal and spontaneous delivery of placenta on post-cesarean endometritis and duration of cesarean operation.

In this prospective (control–case) study, 280 pregnant women undergoing elective cesarean delivery in Shahid Sadoughi (Yezed, Iran) teaching hospital were randomly assigned to two groups: manual placental delivery (140 women) and spontaneous placental delivery (140 women). Antibiotic prophylaxis was administered in both groups. The operation time concluded from skin incision to skin repair. Endometritis was diagnosed in patients who developed clinical signs of fever (>38°C) 24 h after delivery, supra-pubic tenderness and vaginal discharge. Data analysis was carried out using t-test and chi square test by SPSS15.0.

The total rate of endometritis was 12.1% (34 women); 12 women in the spontaneous placental delivery group (8.6%) and 22 women in the manual placental removal group (16%). This difference was statistically significant between two groups (P=0.006). There was no statistically significant difference in duration of operation between two groups (P=0.1).

Our finding indicate that manual removal of the placenta increased postpartum endometritis in compared with the spontaneous method of placental removal, but had no influence on the duration of cesarean.