title: Method of placental removal during cesarean delivery and postpartum complications.
abstract: OBJECTIVE
  The study was aimed to determine whether the method of placental removal at the time of the cesarean delivery is associated with postpartum complications such as postpartum fever and wound infection. In addition it was aimed to identify other complications following cesarean delivery.
  
  
  METHODS
  A prospective observational study was conducted, including 426 women who underwent cesarean deliveries between January 2004 and March 2005, in a tertiary medical center. A multivariable logistic regression model, with backward elimination, was constructed in order to identify independent risk factors associated with the occurrence of wound infection or fever. A sample size of about 150 subjects in each group was needed to demonstrate a difference of 15% between the two methods of placental removal, with a probability of 95% and power of 80%.
  
  
  RESULTS
  Manual removal of the placenta occurred in 269 operations while in 157 women the placenta was removed in a spontaneous method. No statistically significant differences were noted between the two methods of removal of the placenta regarding the risk for fever (7.8% in the group of the manual removal, as compared with 5.1% in the group of the spontaneous method; P=0.284) or for wound infection (3.7% in the group of the manual removal compared with 5.1% in the group of the spontaneous method; P=0.495). Using a multivariable logistic regression model, with backward elimination, the following risk factors were identified for postcesarean fever, or wound infection: unskilled surgeon (OR 3.2, 95% CI 1.4-7.8), number of previous cesarean deliveries (OR 1.8, 95% CI 1.3-2.6) and maternal hypertension (OR 3.3, 95% CI 2.0-38.5).
  
  
  CONCLUSIONS
  The method of placental removal during cesarean delivery is not associated with the risk for either wound infection or postpartum fever.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Merchavy
authors.forename: A
authors.initials: A
authors.lastname: Levy
authors.forename: G
authors.initials: G
authors.lastname: Holcberg
authors.forename: E N
authors.initials: EN
authors.lastname: Freedman
authors.forename: E
authors.initials: E
authors.lastname: Sheiner
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects* / Q000379:methods; D002983:Clinical Competence; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000150:complications; D007396:Internship and Residency; D007557:Israel; D016017:Odds Ratio; D010920:Placenta / Q000601:surgery*; D011247:Pregnancy; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000209:etiology*