How can methods of placental delivery in cesarean section affect perioperative blood loss? A randomized controlled trial of controlled cord traction versus manual removal of placenta

Altraigey, Ahmed; Ellaithy, Mohamed; Atia, Hytham; Ali, Ibrahim; Kolkailah, Mohamed; Abbas, Ahmed M.

doi:10.1111/jog.13797

Cited by 9 publications

(4 citation statements)

References 26 publications

(38 reference statements)

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“…These results were similar to that obtained by Ramadani (14) in which he reported that there was no significant difference in the rate of blood transfusion six patients in spontaneous separation group and five patients in manual removal group received blood transfusions. Different results were reported by Altraigey et al (20) in which they reported that there was a statistically significant higher need for using extra ecbolics among the group of spontaneous separation of placenta.…”

Section: Discussionmentioning

confidence: 57%

Spontaneous Separation Versus Manual Removal of Placenta During Elective Cesarean Section Regarding Blood Loss

El-behiedy

Soliman

Ali

et al. 2021

The Egyptian Journal of Hospital Medicine

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Background: Cesarean section (CS) rates have increased; this is especially concerning in developing countries. The mode of placental delivery contributes to morbidity associated with CS, and determines blood loss during CS. Objective: The aim of the work was to compare spontaneous placental delivery with cord traction and manual removal of placenta as regards amount of blood loss during elective cesarean section. Patients and Methods: This prospective Cohort study included a total of 48 Women prepared for elective cesarean section, attending at Zagazig University Hospitals and Zagazig General Hospital. This study was conducted between April 2019 to October 2019. The included subjects were divided into two groups (24 each) regarding methods of placental delivery. Group A; placenta was allowed to be separated spontaneously and removed by gentle cord traction. Group B; placenta was removed manually by the surgeon's hand introduced into the uterine cavity and cleavage plane was created between the placenta and decidua basalis following which the placenta was grasped and removed. With the use of oxytocin by intravenous infusion 20 units after delivery of the baby in both groups. Results: Blood loss in spontaneous placental separation group was (881.67 ± 74.54) ml, but in manual placental separation group was (962.79 ± 116.11) ml, (p<0.01). The preoperative hemoglobin (g/dl) in spontaneous separation group was (11.3 ± 1.07) and in manual separation group was (11.63 ± 1.11), postoperative hemoglobin in spontaneous separation group was (10.3 ± 0.83) and in manual separation group was (9.42 ± 0.74). Conclusion:Manual removal of placenta only seems to be superior in saving the time taken to extract out placenta. Manual removal of placenta adds to the post-operative complications in form of greater blood loss and infections.

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Section: Discussionmentioning

confidence: 57%

Spontaneous Separation Versus Manual Removal of Placenta During Elective Cesarean Section Regarding Blood Loss

El-behiedy

Soliman

Ali

et al. 2021

The Egyptian Journal of Hospital Medicine

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“…Nurses at the forefront of patient care during childbirth possess a crucial understanding of AMTSL. They are wellversed in administering uterotonic agents, such as oxytocin or misoprostol, which stimulate uterine contractions, thereby aiding in the prompt separation and expulsion of the placenta (Altraigey et al, 2019). Nurses are skilled in monitoring the mother's vital signs and uterine contractions to gauge the effectiveness of these medications and ensure the prevention of excessive bleeding (Ramesh et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Nurse's Knowledge Regarding Active Management of The Third Stage of Labor to Control Postpartum Hemorrhage

Mohammed,

Aliwi

2024

Journal-Pharmacy

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Background: Postpartum hemorrhage is a leading cause of maternal mortality and morbidity globally. The third stage of labor begins after the baby is born and ends with the delivery of the placenta. During this stage, the uterus needs to contract effectively to prevent excessive bleeding. Active Management of the Third Stage of Labor was introduced as a strategy to reduce the risk of postpartum hemorrhage. The study aimed to investigate nurses' knowledge of active management of the third stage of labor to control postpartum hemorrhage and investigate associated factors. Results: The study examined participant characteristics, revealing an average age of 35.93 (SD=8.52). Around 65.0% of nurses in the study had graduated from preparatory nursing. Most nurses (56.7%) had 5-10 years of hospital experience. A majority (65.0%) worked in postpartum areas. Over half (58.3%) had 4-6 years of experience without training. The study evaluated nurses' knowledge of active management of the third stage of labor, with responses on a scale ranging from 37-64. The overall expertise indicates that 75.0% of nurses needed a better understanding. The results highlighted that factors like nurses' education level (p= .024) and training courses (p= .041) predicted their knowledge of active management of the third stage of labor. Conclusions: The study found that nurses' knowledge of active management of the third stage of labor varied, overall indicating a poor understanding of nurses. The results highlighted significant predictors of this knowledge, including education level and participation in training courses. To enhance nurses' proficiency in active management of the third stage, it is recommended to focus on targeted educational programs and regular training opportunities.

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“… 3 But the ideal method of placental removal during CS is still a controversial issue. 15 The choice mainly bases on the surgeon’s preference. At present, the research of placenta resection technology mainly focus on “manual” or “spontaneous” removal.…”

Section: Introductionmentioning

confidence: 99%

“… 14 , 16 Manual placental removal remains a conflicting issue owing to the risk of postpartum hemorrhage, postpartum endometritis, and placental abnormalities in subsequent pregnancies. 13 , 15 , 17 …”

Section: Introductionmentioning

confidence: 99%

Manual Removal versus Spontaneous Delivery of the Placenta at Cesarean Section: A Meta-Analysis of Randomized Controlled Trials

Yang¹,

Su²,

Jiang³

et al. 2021

TCRM

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Several randomized clinical trials (RCTs) investigated the effects of the manual placental removal on hemorrhage or other hemorrhage-related complications compared with the spontaneous placental removal during cesarean section (CS), while the results remained controversial and were inconsistent. The purpose of this meta-analysis was to quantify the pooled effects of the methods of placental removal on hemorrhage during CS. Patients and Methods: A systematic literature search was conducted using PubMed, EMBASE, Web of Science, and Google Scholar. Heterogeneity was tested by I 2 statistics and Q-statistic. The random-effects model or fixed-effects model were used to calculate the pooled effect for the included studies according to heterogeneity. And the term of standardized mean difference (SMD) with 95% confidence intervals (CI) was pooled and estimated the effects across all studies. Results: A total of nine RCTs were included in this meta-analysis. Compared with spontaneous group, manual placental removal increased the amount of hemorrhage (SMD = 0.53, 95% CI [0.12, 0.94]; Z = 2.54, P = 0.011) and increased the risk of endometritis (OR = 1.84, 95% CI [1.31, 2.58]; Z = 3.52, P < 0.0001). In contrast, there was no significant difference concerning the operating time (SMD = −0.30, 95% CI [−0.85, 0.24]; Z = 1.09, P = 0.276), the length of hospital stays (SMD = 0.11, 95% CI [−0.08, 0.30]; Z = 1.11, P = 0.265), and blood transfusion requirement (OR = 1.36, 95% CI [0.91, 2.04]; Z = 1.52, P = 0.129), respectively. Conclusion: Comparing with spontaneous placental removal, manual placental removal appeared to be less positive effect during CS. Because of the limitations of this metaanalysis, more high-quality RCTs are needed to confirm our findings.

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How can methods of placental delivery in cesarean section affect perioperative blood loss? A randomized controlled trial of controlled cord traction versus manual removal of placenta

Abstract: Of the studied placental delivery techniques, there were no clinically significant differences in terms of the considered intraoperative and postoperative outcomes; hence, the practice of placental delivery can be left up to obstetrician's discretion and intraoperative scenario.

Cited by 9 publications

References 26 publications

Spontaneous Separation Versus Manual Removal of Placenta During Elective Cesarean Section Regarding Blood Loss

Spontaneous Separation Versus Manual Removal of Placenta During Elective Cesarean Section Regarding Blood Loss

Nurse's Knowledge Regarding Active Management of The Third Stage of Labor to Control Postpartum Hemorrhage

Manual Removal versus Spontaneous Delivery of the Placenta at Cesarean Section: A Meta-Analysis of Randomized Controlled Trials

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