Abstract
Purpose
The aim of this prospective randomized clinical study is to compare whether the removal methods of placenta during cesarean section have an impact on perioperative hemorrhage.
Methods
One hundred women with singleton term pregnancies undergoing elective cesarean section through lower segment transverse incision under general anesthesia were included in this study. They were randomly allocated to two groups according to the type of removal of the placenta from the uterus after childbirth; manually or spontaneously. The main outcome measures were change in hemoglobin levels after cesarean section. The secondary outcomes were operative time, required transfusions and postcesarean endometritis.
Results
Fifty patients were randomized to the manual removal group and 50 to the spontaneous group. The demographic characteristics of the two groups were similar. There were no difference in terms of change in hemoglobin levels after cesarean section between two groups (1.6 ± 1.0 and 1.5 ± 1.0, respectively; P = 0.711). In addition, none of the patients required blood transfusion and showed postpartum infections.
Conclusion
There is not an association between the method of removal of the placenta and postpartum blood loss in cesarean section deliveries.
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References
Barber EL, Lundsberg LS, Belanger K, Pettker CM, Funai EF, Illuzzi JL (2011) Indications contributing to the increasing cesarean delivery rate. Obstet Gynecol 118(1):29–38
van Ham MA, van Dongen PW, Mulder J (1997) Maternal consequences of caesarean section. A retrospective study of intra-operative and postoperative maternal complications of caesarean section during a 10-year period. Eur J Obstet Gynecol Reprod Biol 74(1):1–6
Ronsmans C, Graham WJ (2006) Lancet Maternal Survival Series steering group. Maternal mortality: who, when, where, and why. Lancet 368(9542):1189–1200
Schorn MN (2010) Measurement of blood loss: review of the literature. J Midwifery Womens Health 55(1):20–27
Walsh CA, Manias T, Brockelsby J (2007) Relationship between haemoglobin change and estimated blood loss after delivery. BJOG 114(11):1447–1448
Al Kadri HM, Al Anazi BK, Tamim HM (2011) Visual estimation versus gravimetric measurement of postpartum blood loss: a prospective cohort study. Arch Gynecol Obstet 283(6):1207–1213
Hofmeyr JG, Natalia Novikova N, Mathai M, Shah A (2009) Techniques for cesarean section. Am J Obstet Gynecol 201(5):431–444
Anorlu RI, Maholwana B, Hofmeyr GJ (2008) Methods of delivering the placenta at caesarean section. Cochrane Database Syst Rev 16(3):CD004737
Baksu A, Kalan A, Ozkan A, Baksu B, Tekelioglu M, Goker N (2005) The effect of placental removal method and site of uterine repair on postcesarean endometritis and operative blood loss. Acta Obstet Gynecol Scand 84(3):266–269
Miller DA, Chollet JA, Goodwin TM (1997) Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol 177(1):210–214
Chandra P, Schiavello HJ, Kluge JE, Holloway SL (2002) Manual removal of the placenta and postcesarean endometritis. J Reprod Med 47(2):101–106
Dehbashi S, Honarvar M, Fardi FH (2004) Manual removal or spontaneous placental delivery and postcesarean endometritis and bleeding. Int J Gynaecol Obstet 86(1):12–15
Gol M, Baloglu A, Aydin C, Ova L, Yensel U, Karci L (2004) Does manual removal of the placenta affect operative blood loss during cesarean section? Eur J Obstet Gynecol Reprod Biol 112(1):57–60
Hidar S, Jennane TM, Bouguizane S, Lassoued L, Bibi M, Khaïri H (2004) The effect of placental removal method at cesarean delivery on perioperative hemorrhage: a randomized clinical trial ISRCTN 49779257. Eur J Obstet Gynecol Reprod Biol 117(2):179–182
Ramadani H (2004) Cesarean section intraoperative blood loss and mode of plasental separation. Int J Gynaecol Obstet 87(2):114–118
McCurdy CM Jr, Magann EF, McCurdy CJ, Saltzman AK (1992) The effect of placental management at cesarean delivery on operative blood loss. Am J Obstet Gynecol 167(5):1363–1367
Hacettepe University Institute of Population Studies, Turkish Demographic and Health Survey (2008) Hacettepe University Institute of Population Studies, Ministry of Health of Mother and Child Health and Directorate General of Family Planning, Prime Ministry Undersecretariat of State Planning Organization and TUBITAK, Ankara, Turkey, 2009
Kolas T, Saugstad OD, Daltveit AK, Nilsen ST, Oian P (2006) Planned cesarean versus planned vaginal delivery at term: comparison of newborn infant outcomes. Am J Obstet Gynecol 195(6):1538–1543
Lilford RJ, van Coeverden de Groot HA, Moore PJ, Bingham P (1990) The relative risks of caesarean section (intrapartum and elective) and vaginal delivery: a detailed analysis to exclude the effects of medical disorders and other acute pre-existing physiological disturbances. Br J Obstet Gynaecol 97(10):883–892
Lasley DS, Eblen A, Yancey MK, Duff P (1997) The effect of placental removal method on the incidence of postcesarean infections. Am J Obstet Gynecol 176(6):1250–1254
Magann EF, Dodson MK, Allbert JR, Mc-Curdy CM Jr, Martin RW, Morrison JC (1993) Blood loss at time of cesarean section by method of placental removal and exteriorization versus in situ repair of the uterine incision. Surg Gynecol Obstet 177(4):389–392
Magann EF, Washburne JF, Harris RL, Bass JD, Duff WP, Morrison JC (1995) Infectious morbidity, operative blood loss, and length of the operative procedure after cesarean delivery by method of placental removal and site of uterine repair. J Am Coll Surg 181(6):517–520
Atkinson MW, Owen J, Wren A, Hauth JC (1996) The effect of manual removal of the placenta on post-cesarean Endometritis. Obstet Gynecol 87(1):99–102
Al-Zirqi I, Vangen S, Forsen L, Stray-Pedersen B (2008) Prevalence and risk factors of severe obstetric haemorrhage. BJOG 115(10):1265–1272
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Gün, İ., Özdamar, Ö., Ertuğrul, S. et al. The effect of placental removal method on perioperative hemorrhage at cesarean delivery; a randomized clinical trial. Arch Gynecol Obstet 288, 563–567 (2013). https://doi.org/10.1007/s00404-013-2759-2
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DOI: https://doi.org/10.1007/s00404-013-2759-2