title: The effect of placental removal method and site of uterine repair on postcesarean endometritis and operative blood loss.
abstract: BACKGROUND
  Our purpose was to determine whether blood loss during cesarean section and postoperative endometritis rate were associated with the method of placental removal and site of uterine repair.
  
  
  METHODS
  This prospective randomized study involved 840 women who underwent cesarean section. The patients were grouped into four: (1) manual placental delivery + exteriorized uterine repair; (2) spontaneous placental delivery + exteriorized uterine repair; (3) manual placental delivery + in situ uterine repair; (4) spontaneous placental delivery + in situ uterine repair. Patients were excluded if they had received intrapartum antibiotics, had chorioamnionitis, required an emergency cesarean hysterectomy, had rupture of membranes for more than 12 hr, had bleeding diathesis, and had abnormal placentation or prior postpartum hemorrhage. The main outcome measures were postoperative hemoglobin and hematocrit values, and postcesarean endometritis.
  
  
  RESULTS
  There were no statistically significant differences in mean maternal age, parity, gestational age, presence and duration of membrane rupture and number of vaginal examinations between the four groups. The decrease in postoperative hemoglobin (P < 0.05) and hematocrit (P < 0.001) was significantly greater in the manual removal groups (groups 1 and 3) than in the spontaneous expulsion groups (groups 2 and 4) at 48 hr postoperatively. The incidence of postoperative endometritis was significantly higher in manual removal groups (15.2%) (groups 1 and 3) than in spontaneous groups (5.7%) (groups 2 and 4) (P < 0.05).
  
  
  CONCLUSIONS
  Manual removal of the placenta at cesarean delivery results in more operative blood loss and a higher incidence of postcesarean endometritis.
authors.affiliation: 1st Obstetrics and Gynecology Clinic, Sisli Etfal Training and Research Hospital, Istanbul, Turkey. alpbaksu@yahoo.com
authors.forename: Alparslan
authors.initials: A
authors.lastname: Baksu
authors.forename: Aysel
authors.initials: A
authors.lastname: Kalan
authors.forename: Arzu
authors.initials: A
authors.lastname: Ozkan
authors.forename: Başak
authors.initials: B
authors.lastname: Baksu
authors.forename: Meltem
authors.initials: M
authors.lastname: Tekelioğlu
authors.forename: Nimet
authors.initials: N
authors.lastname: Goker
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods*; D004716:Endometritis / Q000097:blood / Q000453:epidemiology*; D005260:Female; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D015994:Incidence; D011184:Postoperative Period; D006473:Postpartum Hemorrhage / Q000097:blood / Q000453:epidemiology; D011247:Pregnancy; D011446:Prospective Studies; D011645:Puerperal Infection / Q000453:epidemiology; D014421:Turkey / Q000453:epidemiology; D014599:Uterus / Q000601:surgery*
chemical_list: D006454:Hemoglobins