Complications; Cesarean Section Clinical Trial
Official title:
How Can Methods of Placental Delivery Affect the Amount of Blood Loss During Cesarean Section?
To compare between the effect of controlled cord traction and manual removal of the placenta on blood loss among women undergoing caesarean sections
Cesarean section (CS) is one of the most commonly performed major abdominal operations in
women worldwide and its rate is increasing dramatically every year.
Some of the reported short-term morbidities include hemorrhage, postoperative fever and
endometritis. The method of delivering the placenta is one procedure that may contribute to
an increase or decrease in the morbidity of CS.
On an average 0.5-1 liter of blood is lost during CS, many variable techniques have been
tried to reduce this blood loss. Such techniques include finger splitting versus scissor
cutting of incision, in situ stitching verses exteriorization and stitching of uterus , and
finally spontaneous or manual removal of the placenta.
Two common methods used to deliver the placenta at CS are cord traction and manual removal.
Manual removal of the placenta which the obstetrician introduce his hand into the uterine
cavity to cleave the placenta from the decidua basalis as soon as possible after the
delivery of the infant and controlled cord traction in which the obstetrician do external
uterine massage and gentle traction on the exposed umbilical cord to facilitate placental
delivery.
Opinions differ about the best for placental delivery technique at CS. Some trials showed a
reduced risk of blood loss with controlled cord traction (3) and others showed that manual
removal of placenta at CS do not increase perioperative blood loss.
Authors concluded that manual delivery of the placenta was significantly associated with
greater operative blood loss and greater decrease in postoperative hemoglobin levels and
postpartum maternal infectious morbidity but with shorter operative time compared with
spontaneous placental separation .
In addition, it is known that the blood loss at CS delivery is difficult to estimate, and
numerous different methods including serial change in hematocrit (Hct), hemoglobin (Hb)
level, visual estimation and the gravimetric method are described.
A low, but significant, correlation was found between visually estimated blood loss and
perioperative hemoglobin change in women delivering by CS. However, hemoglobin , hematocrit
levels and visual estimation are the most commonly used technique for estimating blood loss
at delivery.
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