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Acta Obstet Gynecol Scand. 1999 Jan;78(1):33-6.

Manual removal of the placenta. Incidence and clinical significance.

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  • 1Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.

Abstract

OBJECTIVE:

To determine the incidence and complications related to manual removal of the placenta.

METHODS:

Review of hospital medical records from 1990 throughout 1994. One thousand five hundred and two vaginal deliveries from 1984 1992 were used for comparisons.

RESULTS:

A total of 24,750 deliveries were registered during the five year study period. Placenta was removed manually in 165 women (0.6%). The use of general anesthesia for manual removal of placenta decreased from 74% in 1990 to 19% in 1994. Spinal analgesia was applied from 1993, and it was used in 42% of the women in 1994. Of 74 parous women, 12 (16%) had experienced retained placenta before. The average difference in the hemoglobin concentration between the prenatal and the postoperative values was 3.4 g/dl among the patients, and 10% required blood transfusion (1-4 units). Among the controls, there was no decrease in the average hemoglobin concentration, and only 0.5 needed blood transfusion. Endometritis following manual removal was detected in 1.8% of the patients and 1.5% among the controls. Despite manual removal, five women (3%) were considered to have retained placental fragments two days or later after delivery, which required curettage.

CONCLUSIONS:

Placenta needed to be removed manually in 0.60% of all deliveries in our department. It was associated with increased incidence of hemorrhage and consequently low hemoglobin values. Women with a history of retained placenta have an increased risk of recurrence of retained placenta in subsequent deliveries.

PMID:
9926889
[PubMed - indexed for MEDLINE]
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