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Manual removal of the placenta--a case control study
H Titiz1, A Wallace, D C Voaklander
1Goulburn Valley Base Hospital, Shepparton, Victoria, Australia.
Summary
Manual removal of the placenta occurred in 3% of deliveries, leading to increased complications like blood transfusions and a higher risk of hysterectomy for placenta accreta.
Area of Science:
- Obstetrics and Gynecology
- Reproductive Medicine
Background:
- Manual removal of the placenta is a procedure performed when the placenta is not delivered spontaneously after childbirth.
- Retained placenta can lead to significant maternal morbidity.
Purpose of the Study:
- To determine the incidence of manual placenta removal in a regional Australian hospital.
- To identify complications associated with manual placenta removal.
Main Methods:
- Retrospective review of hospital medical records from 1992 to 1999.
- Analysis of 3734 singleton live vaginal deliveries.
- Comparison of 114 cases of manual placenta removal with 113 randomly selected controls.
Main Results:
- Manual placenta removal occurred in 3% of deliveries.
- Cases had significantly higher rates of blood transfusion (13% vs 0%).
- History of retained placenta, preterm delivery, and decreased maternal age were associated with manual removal.
Conclusions:
- Manual placenta removal is associated with increased maternal morbidity, including a need for blood transfusions.
- While not statistically significant, there was a trend towards more post-delivery dilatation and curettage and endomyometritis in the manual removal group.
- One case of placenta accreta necessitated a hysterectomy.