Evaluation of the methods of placental removal during cesarean section and their postpartum complications

Considering increasing rate of cesarean section (C/S) and post operative infection as its consequence, we presumed that manual removal of placenta is associated with increased rate of infection. The aim of this prospective study was to investigate the effect of placental removal methods on the amount of bleeding and development of post operative fever. In this study six hundred patients who needed C/S were assigned randomly into two groups, one group had spontaneous placental delivery (300 patients) and in the other group manual placental removal delivery (300 patients) was performed. All of caesarean sections were done by the same surgeon and after delivery of the neonate and clamping of umbilical cord placenta was either removed manually or spontaneously while massaging uterus and pulling umbilical cord slightly. The amount of bleeding during operation was estimated by measuring blood suctioned and weight of sponges before and after operation. Hct was measured 24 and 48 hours after operation and a 3% decrease of Hct was considered significant. Temperature of each patient was checked orally every four hours after operation. Diagnosis of endometritis was made based on two high temperatures higher than 38 centigrade degree, presence of suprapubic tenderness and alterations in the quality and quantity of lochia. Using SPSS software version 11, sstatistical analysis was performed by means of T test and chi square test. Mean age of the patients was 24.56±5.56 years. Two groups were evaluated and compared for decrease of Hct (>3%) during 24 and 48 hours after surgery which revealed a significant difference (P<0.001). Fever was detected in 27 patients with spontaneous placental delivery (9%) and 44 patients with manual placental delivery (14.7%). The difference between two groups was significant (P<0.05). Comparison of the mean amount of bleeding during operation, measured based on the minimum and maximum weight of sponges and suctioned bloody amniotic fluid, showed a significant difference between two groups (P<0.001). Duration of C/S in two groups showed no significant difference. Considering increased incidence rate of bleeding and development of fever after manual placental delivery compared to spontaneous placental delivery in S/C, we recommend spontaneous placental delivery in C/S in order to lower the incidence of above mentioned complications.