COMPARISON OF SPONTANEOUS AND MANUAL PLACENTA EXTRACTION DURING CESAREAN DELIVERY

Somaia Almohammed Alissa*, Lina Ramadan and Fadi Jaber

ABSTRACT

Background: Placental removal options at cesarean section are either spontaneous with gentle cord traction or
manual, and the mode of placental delivery contributes to morbidity. Objective: The aim of this study was to
compare the effectiveness of spontaneous extraction of placenta versus manual type regarding of intra-operative
blood loss and endometritis. Patients and Methods: A prospective randomized controlled trial study was
conducted for the period one year (2023-2024) at Tishreen University Hospital in Lattakia-Syria. The study
included 400 women underwent cesarean delivery, who were divided into group1 included 200 women with
spontaneous extraction of placenta, and group 2 included 200 women who underwent manual extraction, in which
final outcome was compared between two groups. Results: Ages of the study population ranged from 20 to 37
years, with a mean age of 28.49±3.2, without significant differences between the two groups regarding of
demographic characteristics, obstetric status, and indication of cesarean section (p>0.05). Duration of placental
extraction was significantly lower in manual group(0.39±0.3 versus 2.8±1.7 minute,p:0.001) without significant
differences between two groups regarding of duration of surgery(p:0.2). Compared with manual extraction, blood
loss was significantly lower in spontaneous group(469.6±147 versus 539.8±167 ml,p:0.0001) with less change in
hemoglobin levels at delivery(0.65±0.12 versus 1.63±0.21), as well as low frequency of endometritis(1% versus
3.5%,p:0.04). Conclusion: Spontaneous placental extraction at cesarean section is recommended due to low
frequency of associated morbidity of infection and the need for blood transfusion.

Keywords: Manual, spontaneous, placental extraction, cesarean section.