Association of Placenta Removal Method and Postpartum Leucocytosis
Condition: Cesarean Section Complications
MeSH terms: Leukocytosis
Study type: Interventional

Summary: 
      Cesarean delivery is one of the most common major abdominal operation in women worldwide. The
      incidence of postpartum infection has been estimated to be 1-4% after vaginal delivery and
      10-20% after Cesarean delivery. Although it is widely performed, manual removal of the
      placenta is still a conflicting issue due to the risk of post-partum endometritis. All
      cesarean patients are randomized according to the removal of placenta from the uterus after
      childbirth; manually (Group 1) or controlled cord traction without putting fingers inside the
      uterus (Group 2). The aim of this study is to examine whether there is an association between
      the method of removal of the placenta and postpartum white blood cell increase in nonanemic,
      singleton, low-risk group of women with term pregnancies, who underwent elective cesarean
      delivery under general anesthesia.
    

Detailed description: 
      Objective:

      Cesarean section is one of the most common major abdominal operation in women worldwide and
      its rate is increasing every year. Although cesarean birth is considered as safe, it is a
      potentially morbid procedure with associated risks of hemorrhage, thromboembolic events,
      infection, and anesthesia risks. The incidence of postpartum infection has been estimated to
      be 1-4% after vaginal delivery and 10-20% after cesarean section. Manual removal of the
      placenta is widely accepted by surgeons worldwide. This method enables the surgeon quick
      intervention. Beside, it helps uterine cavity to be examined for damage and the presence of
      placental remnants. However, manual removal of the placenta is still a conflicting issue due
      to the risk of post-partum endometritis, post-partum hemorrhage and abnormal placentation in
      subsequent pregnancies. It is assumed that controlled cord traction reduces the risk of
      postpartum hemorrhage and infection.

      The aim of this study is to examine whether there is an association between the method of
      removal of the placenta and increase in postpartum white blood cell counts

      After informed consent, all patients are randomized according to the removal of placenta from
      the uterus after childbirth; manually (Group 1) or controlled cord traction without putting
      hands inside the uterus (Group 2). Patients are examined regarding to maternal infection. BMI
      measurement, obstetrics and medical history are recorded. The operative procedures are
      similar in all patients and followed the same technical steps. In both groups, oxytocin and a
      first-generation cephalosporin antibiotic are administered intravenously after the delivery
      of the infant. All uterine incisions were low transverse and all were closed without
      exteriorisation of the uterus. Complete blood count before delivery, on pastpartum day 1 and
      2, fever during hospitalisation, average blood loss during operation and the endometritis
      cases are recorded. All the patients are asked to come to control on postpartum day 10. Also,
      patients are asked to come to control if they have fever, abnormal vaginal bleeding, abnormal
      vaginal discharge, general feeling of sickness and pain in the pelvis. Fever is defined as a
      temperature above 38.5°C on two consecutive days, excluding the first 24 hours.
    

Intervention name(s): Controlled cord traction
Intervention type(s): Other
Intervention description(s): In group 2, Spontaneous removal will be performed by massaging on the uterine fundus and applying gentle traction on the umbilical cord.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The operative procedures are similar in all patients and followed the same technical steps. All patients are randomized according to the removal of placenta from the uterus after childbirth; manually removing placenta and control of endometrial cavity by fingers (Group 1) or controlled cord traction without putting fingers inside the uterus (Group 2).
Masking: Single (Investigator)
Primary purpose: Prevention
Keywords: Placenta removal method; postpartum leucocytosis; endometritis; postpartum anemia