THE EFFECT OF MANUAL REMOVAL OF THE PLACENTA ON POSTCESAREAN ENDOMETRITIS

Objective: To determine if intraoperative glove change and placental d elivery method affect the post-cesarean endometritis rate. Methods: Af ter informed consent, women who required cesarean were randomly assign ed to one of four study groups: 1) no glove change plus manual placent al extraction, 2) no glove change plus spontaneous placental delivery, 3) glove change plus manual extraction, and 4) glove change plus spon taneous delivery. Bilateral glove change by both primary and assistant surgeons occurred immediately after delivery of the newborn and befor e delivery of the placenta. External uterine massage and traction on t he umbilical cord were performed to assist spontaneous delivery of the placenta. A first-generation cephalosporin was routinely administered after umbilical cord clamping for prophylaxis of post-cesarean endome tritis. Results: Of 760 women entered into the study, we included 643 who did not have intrapartum chorioamnionitis or cesarean hysterectomy . The four groups were comparable with respect to selected maternal an d intrapartum characteristics, including maternal and gestational age, parity, presence of labor, and the presence and duration of membrane rupture. The postoperative endometritis rate was significantly higher in women whose placentas were extracted manually (31 versus 22%, P =.0 1). Operator glove change did not alter the incidence of endometritis (relative risk 1.0, 95% confidence interval 0.79-1.3). Conclusion: Man ual extraction of the placenta is associated with a significantly grea ter risk of post-cesarean endometritis than that observed with assiste d spontaneous placental delivery. Intraoperative glove change does not decrease post-cesarean endometritis.