Methods of Placental Delivery and the Amount of Blood Loss During Cesarean Section
Condition: Complications; Cesarean Section
MeSH terms: Hemorrhage
Study type: Interventional

Summary: 
      To compare between the effect of controlled cord traction and manual removal of the placenta
      on blood loss among women undergoing caesarean sections
    

Detailed description: 
      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.
    

Intervention name(s): manual removal; cord traction
Intervention type(s): Procedure; Procedure
Intervention description(s): one of the standard procedures for placental delivery during caesarean section the surgeon will introduce his hand into the uterine cavity to cleave the placenta from the decidua basalis as soon as possible after the delivery of the baby; one of the standard procedures for placental delivery during caesarean section the surgeon do external uterine massage and gentle traction on the exposed umbilical cord to facilitate placental delivery
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Other
Keywords: blood loss; caesarean section; placental delivery