Extra-abdominal Removal of Placenta During CS
Condition: the Influence of Intra- vs Extra-abdominal Removal of Placenta; Duration of Operation; the Amount of Aspirated Fluid During the Operation; Difference Between Pre- and Post-operative CBC
Study type: Interventional

Summary: 
      During cesarean section, it is important to provide hemostasis as well as to decrease the
      amount of hemorrhagic fluid and fibrin in the abdominal cavity. Hemorrhagic fluid and fibrin
      together may cause adhesion formation and therefore postoperative ileus, retardation in
      regaining the gastrointestinal functions as well as prolongation of the operation itself.
      Dragging the uterus out of the abdominal cavity during cesarean section before removing the
      placenta (extra-abdominal removal of the placenta) may decrease the amount of blood flowing
      into the abdominal cavity during removal of placenta. In this study the investigators aimed
      to evaluate the influence of intra abdominal vs extra abdominal removal of placenta on
      duration of operation, the amount of aspirated fluid during the operation, difference between
      postoperative hemoglobin and hematocrit levels, postoperative pain score, additional need of
      analgesia, postoperative bowel movements, postoperative endometritis and wound infection.
    

Detailed description: 
      In this study the investigators will recruit 200 pregnant women; 100 women in the study group
      and 100 women in the control group. The women will be randomly allocated in two groups. The
      odd numbered women will be in the study group and even numbered women will be in the control
      group.

      The investigators will perform cesarean section according to the obstetrical indications.
      Lower segment uterine incision will be used during the cesarean section. After the delivery
      of the fetus two distinct procedures will be used in the control and study groups.

      In the control group, the uterus will be left in the abdominal cavity and the placenta will
      be manually removed with uterine massage as soon as possible. After removal of the placenta,
      the uterus will be dragged out of the abdominal cavity. The cesarean incision will be sutured
      with no. 1 Vicryl ®. Uterus will be replaced in the abdominal cavity. Intra-abdominal cavity
      will be cleaned by aspirator and mounted-gauze tampon. The weight of the placenta will be
      measured. The weight of the gauze tampons will be measured with gravimetric method before and
      after use.

      In the study group, at first, the uterus will be dragged out of the abdominal cavity, prior
      to removal of the placenta. The placenta will be manually removed with uterine massage as
      soon as possible. The cesarean incision will be sutured with no. 1 Vicryl ®. Uterus will be
      replaced in the abdominal cavity. Intra-abdominal cavity will be cleaned by aspirator and
      mounted-gauze tampon. The weight of the placenta will be measured. The weight of the gauze
      tampons will be measured with gravimetric method before and after use.

      In both groups, the abdominal cavity will be closed as appropriate. The vital signs (blood
      pressure and heart rate) will be monitored. Postoperative blood samples for complete blood
      count (CBC) will be taken 24 hours after the operation. Bowel movements will be assessed
      every 6 hours by a stethoscope. Time of the first flatulence will be recorded. Visual Analog
      Scoring (VAS) survey validated in Turkey will be performed in the postoperative 1. and 2.
      days. The type and amount of postoperative analgesics will be recorded. The body temperature
      will regularly be assessed in the first 24. and 48. hours. The presence of fever will be
      recorded.
    

Intervention name(s): Extra-abdominal removal of the placenta; Extra-abdominal removal of the placenta; Extra-abdominal removal of the placenta; Extra-abdominal removal of the placenta
Intervention type(s): Procedure; Procedure; Procedure; Procedure
Intervention description(s): The uterus will be dragged out of the abdominal cavity, prior to removal of the placenta.; The placenta will be manually removed extra-abdominally, with uterine massage as soon as possible.; The cesarean incision will be sutured with no. 1 Vicryl ®.; Uterus will be replaced in the abdominal cavity.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: extra-abdominal; intra-abdominal; removal of placenta; cesarean section; bleeding