title: Infectious morbidity, operative blood loss, and length of the operative procedure after cesarean delivery by method of placental removal and site of uterine repair.
abstract: OBJECTIVE
  This study was done to determine the impact of the method of placental removal and the site of uterine repair on postcesarean infectious morbidity rates in women receiving prophylactic antibiotics at cesarean delivery.
  
  
  METHODS
  This prospective study included 284 women who underwent cesarean delivery and who were randomly assigned to four groups based on the method of placental removal and the site of uterine repair: group 1, spontaneous placental removal and in situ uterine repair; group 2, spontaneous placental removal and exteriorized uterine repair; group 3, manual placental removal and in situ uterine repair; and group 4, manual placental removal with exteriorized uterine repair. Exclusion criteria were repeat cesarean deliveries without labor, active infection at the time of cesarean delivery, and patient refusal to participate.
  
  
  RESULTS
  There was no significant difference among the groups in maternal age, race, parity, weight, the length of time from rupture of membranes (ROM) or the number of vaginal examinations from ROM to cesarean delivery, or preoperative hematocrit. Intraoperatively, the type of uterine incision, anesthesia administered, incidence of meconium-stained amniotic fluid, Apgar scores, and cord gases were similar between groups. The incidence of postcesarean endometritis was greater in group 4 (32 [45 percent] of 71, p = 0.003) compared with group 1 (17 [24 percent] of 71), group 2 (12 [30 percent] of 71); and group 3 (13 [18 percent] of 71).
  
  
  CONCLUSIONS
  Manual placental removal and exteriorization of the uterus for repair of the surgical incision increases the infectious morbidity rate in women receiving prophylactic antibiotics at the time of cesarean delivery and increases the length of hospitalization.
authors.affiliation: Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216-4505, USA.
authors.forename: E F
authors.initials: EF
authors.lastname: Magann
authors.forename: J F
authors.initials: JF
authors.lastname: Washburne
authors.forename: R L
authors.initials: RL
authors.lastname: Harris
authors.forename: J D
authors.initials: JD
authors.lastname: Bass
authors.forename: W P
authors.initials: WP
authors.lastname: Duff
authors.forename: J C
authors.initials: JC
authors.lastname: Morrison
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D009017:Morbidity; D011247:Pregnancy; D011446:Prospective Studies; D011645:Puerperal Infection / Q000453:epidemiology*; D013997:Time Factors; D014599:Uterus / Q000601:surgery