BLOOD-LOSS AT TIME OF CESAREAN-SECTION BY METHOD OF PLACENTAL REMOVALAND EXTERIORIZATION VERSUS IN-SITU REPAIR OF THE UTERINE INCISION

The current study was undertaken to determine if blood loss at the tim e of cesarean section is affected by method of placental removal (spon taneous versus extracted) or uterine position for repair (in situ vers us exteriorized). This prospective randomized study involved 100 women who were undergoing a cesarean section. The patients were placed into one of four groups-1, spontaneous placenta detachment, in situ uterin e repair; 2, spontaneous placental detachment, exteriorized uterine re pair; 3, manual placental removal, in situ uterine repair, and 4, manu al placental removal, exteriorized uterine repair. Patients with spont aneous placental separation (groups 1 and 2) compared with manual remo val (groups 3 and 4) revealed a significant decrease in blood loss (p< 0.001). Uterine position did not significantly affect blood loss in th e spontaneous group (1 and 2; p=0.971) or die manual placental removal groups (3 and 4; p=0.061). The hematocrit values for all groups were similar preoperatively, but postoperatively, were significantly lower in the manual removal groups when compared with the spontaneous placen tal separation groups (p<0.001). The method of placental removal and n ot the position of the uterus at the time of its repair has a signific ant role in blood loss during cesarean birth.