Related Experiment Video
Updated: Aug 23, 2026
Mouse Model of Surgical Uterine Injury and Subsequent Pregnancy Outcomes
Published on: June 27, 2025
Manual removal or spontaneous placental delivery and postcesarean endometritis and bleeding
S Dehbashi1, M Honarvar, F H Fardi
1Shiraz University of Medical Sciences, Shiraz, Iran. dhbashi@sums.ac.ir
Objectives:
To compare the effect of manual removal and spontaneous delivery of placenta on postcesarean bleeding and endometritis.
Methods:
In this prospective study 400 pregnant women undergoing elective cesarean delivery were randomly assigned to two groups: spontaneous placental delivery (200 women) and manual placental delivery (200). No antibiotic prophylaxis was administered in either group. The significance of blood loss due to cesarean delivery was defined by a drop in hemoglobin concentration of more than 1 g/dl 24 h after delivery in comparison with preoperative hemoglobin concentration. Endometritis was diagnosed in patients who developed clinical signs of fever and suprapubic tenderness 48 h after delivery. We analyzed the data using a t-test.
Results:
The overall endometritis rate was 27%, in 40 women in the spontaneous placental delivery group (20%) and 68 women in the manual placental removal group (34%). There was a statistically significant difference between the two groups (P=0.001). Significant blood loss was experienced by 52 women (26%) in the spontaneous placental delivery group vs. 100 women (50%) in the manual placental delivery group. There was a statistically significant difference in blood loss between the two groups (P=0.000; RR=1.92).
Conclusion:
Endometritis and blood loss in cesarean delivery is increased by manual removal of the placenta compared with the spontaneous method of placental removal.
