title: Reducing hemodynamic compromise with placental removal at 10 versus 15 minutes: a randomized clinical trial.
abstract: OBJECTIVE
  To determine if hemodynamic compromise can be reduced with manual placental removal at 10 compared with 15 minutes.
  
  
  METHODS
  Singleton pregnancies admitted for delivery with no contraindication to a vaginal delivery were randomized to a 10-minute group (placentas manually removed if not spontaneously delivered by 10 minutes) versus a 15-minute group. The primary outcome, hemodynamic compromise, was defined as: blood loss exceeding 1000 mL and/or circulatory instability (inability to maintain blood pressure/pulse secondary to acute blood loss) and/or drop in hematocrit of ≥10 percentage points.
  
  
  RESULTS
  From July 2006 to July 2010, 156 women were randomized into the 10-minute group and 156 in the 15-minute group. Women in the 15-minute group had a greater likelihood of hemodynamic compromise univariately (19.2% versus 6.4%, p = 0.001) and after adjustments for ethnicity, induction rate, duration of second stage of labor, and nulliparity (relative risk 3.03, 95% confidence interval 1.52 to 5.47, p = 0.002).
  
  
  CONCLUSIONS
  Hemodynamic compromise is decreased with manual placental removal within 10 minutes of delivery compared with 15 minutes.
authors.affiliation: Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA. efmagann@uams.edu
authors.forename: Everett F
authors.initials: EF
authors.lastname: Magann
authors.forename: Amy
authors.initials: A
authors.lastname: Niederhauser
authors.forename: Dorota A
authors.initials: DA
authors.lastname: Doherty
authors.forename: Suneet P
authors.initials: SP
authors.lastname: Chauhan
authors.forename: Adam T
authors.initials: AT
authors.lastname: Sandlin
authors.forename: John C
authors.initials: JC
authors.lastname: Morrison
mesh_terms: D000328:Adult; D001794:Blood Pressure; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006400:Hematocrit; D006439:Hemodynamics; D006801:Humans; D007749:Labor Stage, Third / Q000502:physiology*; D007744:Obstetric Labor Complications / Q000503:physiopathology* / Q000517:prevention & control; D006473:Postpartum Hemorrhage / Q000517:prevention & control; D011247:Pregnancy; D013997:Time Factors; D055815:Young Adult