THE ASSOCIATION BETWEEN MANUAL REMOVAL OF THE PLACENTA AND POSTPARTUMENDOMETRITIS FOLLOWING VAGINAL DELIVERY

Objective: To determine whether manual removal of the placenta after v aginal delivery is a risk factor for postpartum endometritis. Methods: A retrospective cohort study of vaginal deliveries compared 1052 pati ents who had manual removal of the placenta with 1085 patients whose p lacentas delivered spontaneously. Subjects were selected randomly from the 25,687 vaginal deliveries at the University of Iowa Hospitals dur ing 1979-1992. The presence of endometritis was determined using infor mation in medical records. The data were analyzed using odds ratios (O R) and multiple logistic regression. Results: After controlling for co nfounding variables, manual removal of the placenta was associated wit h postpartum endometritis (adjusted OR 2.9, 95% confidence interval [C I] 1.7-4.9). Other risk factors for endometritis included maternal age less than 17 years (OR 3.3, 95% CI 1.5-7.2), postpartum anemia (OR 2. 9, 95% CI 1.9-4.5), and membranes ruptured longer than 24 hours (OR 2. 5, 95% CI 1.4-4.3). Conclusion: Manual removal of the placenta is a ri sk factor for postpartum endometritis after vaginal delivery.