The Effect of Placental Spontaneous Delivery Versus Manual Removal on Blood Loss During Cesarean Section. A Comparative Study

Study Overview
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Brief Summary
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The mode of placental delivery may contribute to an increase or decrease in the morbidity associated with CS, and many studies have shown it to be a key role in determining the blood loss during CS. Manual removal of the placenta has been implicated in increased blood loss during CS. However, other researchers concluded that it had no detrimental effect on blood loss

Official Title
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The Effect of Placental Spontaneous Delivery Versus Manual Removal on Blood Loss During Cesarean Section. A Comparative Study

Conditions
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Cesarean Section Complications

Intervention / Treatment
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* Procedure: Manual placental separation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age (18 - 35) years. Primigravida. Unscarred uterus. Singleton pregnancy. Living baby. Body mass index (18 - 30) 37-40 weeks Exclusion Criteria: Emergency cesarean section due to possibility of maternal distress and blood loss. Cesarean hysterectomy as the placenta will be removed with the uterus. Abnormally adherent placenta: Placenta accrete, percreta or placenta previa due to failure of placental separation. Previous cesarean section as the previous scar may affect placental separation. Body mass index less than 18 and more than 30 as extremes of body weight may be associated with increased risks of anemia, bleeding and/or infection. Suspected chorioamnionitis to decrease the risk of disseminated infection. Bleeding disorders to decrease blood loss. Multiple pregnancy due to larger placental volume and blood loss compared with singleton. Any pelvic surgery (Appendix - Ovarian cyst. - Ectopic Pregnancy - pelvic abscess) Women with medical illness e.g. pre-eclampsia, anemia (Hb less than 11 gm/dl), DM, Cardiac, Renal …etc. to decrease the risk of maternal morbidity.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 35 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Spontaneous separation<br> | |
| Experimental: Manual separation<br> | Procedure: Manual placental separation<br>* Manual separation of the placenta from uterus<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Blood loss | The blood loss during cesarean section and in the first 24 hours postoperatively will be assessed in a standard manner. Blood will be measured after suction of the mount of amniotic fluid in a separate suction bottle. Amount of blood which collected from towels will be measured according to gravimetric method which reported by Liu et al. (2020). - EBV x (Hi-Hf)/Hi: Where the Hi is the preoperative blood hematocrit, Hf is the postoperative one and EBV is the estimated blood volume. The estimated blood volume could be calculated by multiplying weight times average blood volume which is around 65 ml/kg in females (Miller et al., 2000). | 24 hours |