title: The comparison of placental removal methods on operative blood loss.
abstract: BACKGROUND
  On an average 1 litre of blood is lost during Caesarean Section. Many variable techniques have been tried to reduce this blood loss. Many study trials have shown the spontaneous delivery of placenta method to be superior over manual method because of reduced intra operative blood loss and reduced incidence of post operative endometritis. The main objective of our study was to compare the risk of blood loss associated with spontaneous and manual removal of the placenta during caesarean section.
  
  
  METHODS
  Quasi Experimental. SETTING AND DURATION OF STUDY: September 2004 to September 2005, a 13 months study at Islamic International Medical Complex Islamabad.
  
  
  METHODS
  This study was conducted at Department of Obstetrics and Gynaecology, Islamic International Medical Complex, Islamabad from September 2004 to September 2005. All Women undergoing elective or emergency caesarean section were included in the study. Exclusion criteria were pregnancy below 37 weeks, severe maternal anaemia, and prolonged rupture of the membranes with fever, placenta praevia, placenta accreta and clotting disorders. Patients were allocated to the two groups randomly. Group A comprised of women in whom the obstetrician waited a maximum of 5 minutes till the placenta delivered spontaneously. In group B the obstetrician manually cleaved out the placenta as soon as the infant was delivered. The primary outcome measures noted were difference in haemoglobin of >2 gm/dl (preoperatively and postoperatively), time interval between delivery of baby and placenta, significant blood loss (>1000 cc), additional use of oxytocics, total operating time and blood transfusions. Data was analysed by SPSS. Statistical tests used for specific comparison were chi2-test and Student's t-test.
  
  
  RESULTS
  One hundred and forty-five patients were allocated to two groups randomly. Seventy-eight patients were allocated to group A and 67 patients allocated to group B. Mean maternal age, birth weight, and total operating time were the same in two groups, but blood loss as measured by a difference in haemoglobin of greater then 2 grams/dl was statistically significant. Significant blood loss (>1000 cc) and time interval between delivery of infant and placenta were also statistically significant between the two groups.
  
  
  CONCLUSIONS
  Spontaneous delivery of placenta has significant reduction of blood loss as compared to manual removal at caesarean section.
authors.affiliation: Department of Obstetrics and Gynaecology, Islamic International Medical College, Rawalpindi, *Ayub Medical College, Abbottabad. Fareesa_w@hotmail.com
authors.forename: Fareesa
authors.initials: F
authors.lastname: Waqar
authors.forename: Razia
authors.initials: R
authors.lastname: Nasar
authors.forename: Anisa
authors.initials: A
authors.lastname: Fawad
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002585:Cesarean Section; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007749:Labor Stage, Third; D010920:Placenta; D011247:Pregnancy; D013048:Specimen Handling / Q000379:methods*; D013997:Time Factors