title: Does manual removal of the placenta affect operative blood loss during cesarean section?
abstract: OBJECTIVE
  To investigate whether manual removal of the placenta is associated with significantly more blood loss compared to spontaneous separation of the placenta during cesarean section.
  
  
  METHODS
  This was a randomised study of 200 women with normal pregnancies undergoing cesarean section. Patients were randomly assigned to the study group, manual removal (n=100) or the control group, spontaneous separation (n=100). Operative blood loss was measured using a volume and gravimetric method. Patients postoperative complications were recorded and hemoglobin levels measured at 24 and 48 h.
  
  
  RESULTS
  The amount of blood loss associated with spontaneous and manual removal of the placenta was 626+/-253 ml and 589+/-272 ml, respectively. This difference was not significant. There was a decrease in the postoperative hemoglobin levels in both groups which was not significantly different. The incidence of endometritis, wound infection, and the need for blood transfusion was similar in the two groups.
  
  
  CONCLUSIONS
  Manual delivery of the placenta is not associated with a significantly greater risk of operative blood loss, decreased postoperative hemoglobin levels or increased incidence of endometritis compared with spontaneous placental separation.
authors.affiliation: Dokuz Eylul University, Faculty of Medicine, Department of Obstetrics & Gynecology, Izmir, Turkey. mertgol@egenet.com.tr
authors.forename: Mert
authors.initials: M
authors.lastname: Gol
authors.forename: Ali
authors.initials: A
authors.lastname: Baloglu
authors.forename: Cetin
authors.initials: C
authors.lastname: Aydin
authors.forename: Leylant
authors.initials: L
authors.lastname: Ova
authors.forename: Umur
authors.initials: U
authors.lastname: Yensel
authors.forename: Levent
authors.initials: L
authors.lastname: Karci
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002585:Cesarean Section / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical / Q000379:methods; D006801:Humans; D010920:Placenta; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014592:Uterine Hemorrhage / Q000517:prevention & control*