Risk factors and complications of manual placental removal after vaginal delivery – how common are additional invasive procedures?

Abstract

Manual placental removal harbors short- and long-term complications, including a high likelihood of RPOC necessitating further invasive procedures.

Umbilical vein injection of 400 versus 800 μg misoprostol for the treatment of retained placenta: A multicenter, randomized double‐blind controlled trial

“…Second, the study's sample size was calculated using a pilot study, as we did not find previous reports using these two regimens of misoprostol for retained placenta. Accordingly, we used 250 women in each group, which is a very large number compared with previously published studies with much smaller sample sizes . In addition, we believe that the double‐blinding in this clinical setting increases the importance of the RCT and gives more strength to our current results.…”

“…Retained placenta (RP) is a major cause of maternal mortality due to postpartum hemorrhage and its incidence varies in different countries, being more common in developed countries than developing countries (approximately 3% and 0.5%, respectively, for vaginal deliveries) . A previous systematic review of observational studies was conducted to determine the rate of retained placenta around the world and it revealed that the median proportion of women with retained placenta at 30 min was higher in developed compared with developing countries (2.67% vs 1.46%, respectively), as was the median manual removal rate of placenta (2.24% vs 0.45%, respectively) …”

“…Retained placenta can be managed by the manual removal of placenta (MRP) under general or spinal anesthesia. Manual placental removal is associated with short term complications, like the need for blood product transfusions, genital tract infection, hemorrhage, uterine rupture, prolonged hospitalization and long‐term complications, including a high likelihood of retained placental tissue, further invasive procedures and occasional maternal death . Furthermore, MRP in the operating theater is more feasible in developed countries, while in developing countries the access to obstetrical emergency care, including the availability of an operating theater, presence of skilled personnel and equipment are more limited .…”

Spontaneous resolution of retained products of conception in late pregnancy: retrospective cohort study

“…However, MROP may increase the risk of hysterectomy and death due to heavy bleeding. Additionally, the placenta often remains partly after MROP 5) . If conservative management is chosen immediately after deliver, or RPOC occurs after MROP, there is a risk of subsequent massive haemorrhage or infection [6][7][8][9] .…”

Manual removal of placenta in women having unpredictable adherent placenta

“…Women who underwent MROP after vaginal delivery and where AP was not suspected antenatally may be at higher risk of maternal death in cases of retained placenta. Nevertheless, very little data exist concerning the series of complications following MROP . When searching PubMed with the phrases ‘manual removal of placenta’ and ‘randomized control trial’ and designating the years 1990–2018 as our preferred filter range, results showed that there were no randomized control trials during that period that focused on MROP in terms of its effectiveness and limitations in women where AP was not suspected antenatally.…”