title: The effect of placental removal method at cesarean delivery on perioperative hemorrhage: a randomized clinical trial ISRCTN 49779257.
abstract: OBJECTIVE
  To evaluate whether the method of placental removal during cesarean section has an impact on perioperative hemorrhage and maternal infectious morbidity.
  
  
  METHODS
  Three hundred and two patients admitted for abdominal delivery were recruited in a prospective randomized clinical intention-to-treat trial. Participants were assigned to have their placenta removed either manually or spontaneously. The drop in hematocrit was the primary outcome; postpartum maternal infectious morbidity was also assessed.
  
  
  RESULTS
  Two patients were excluded for incomplete data. One-hundred-fifty-one were randomized to the manual removal group and 149 to the spontaneous group. The demographic characteristics of the two populations were similar. The mean drop (%) in the manual removal group was greater than in the spontaneous group (5.57+/-3.86 and 2.65+/-2.67, respectively; P<0.01). the incidence of postpartum infectious morbidity was also significantly greater in the manual group (RR 15.8, 95% CI 2.19-117.5).
  
  
  CONCLUSIONS
  Routine manual removal of placenta at cesarean section significantly increases perioperative blood loss and postpartum maternal infectious morbidity.
authors.affiliation: Obstetrics and Gynaecology Department, F. Hached University Teaching Hospital, Boulevard M. Karoui 4000 Sousse, Tunisia. hidar.samir@gnet.tn
authors.forename: Samir
authors.initials: S
authors.lastname: Hidar
authors.forename: Taha M
authors.initials: TM
authors.lastname: Jennane
authors.forename: Sassi
authors.initials: S
authors.lastname: Bouguizane
authors.forename: Latifa
authors.initials: L
authors.lastname: Lassoued
authors.forename: Mohamed
authors.initials: M
authors.lastname: Bibi
authors.forename: Hédi
authors.initials: H
authors.lastname: Khaïri
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D010920:Placenta / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000209:etiology; D006473:Postpartum Hemorrhage / Q000209:etiology*; D011247:Pregnancy; D011645:Puerperal Infection / Q000209:etiology*; D016896:Treatment Outcome