Manual removal of the placenta - Incidence and clinical significance

Objective. To determine the incidence and complications related to manual r emoval of the placenta. Methods. Review of hospital medical records from 1990 throughout 1994. One thousand five hundred and two vaginal deliveries from 1984-1992 were used f or comparisons. Results. A total of 24,750 deliveries were registered during the five year study period. Placenta was removed manually in 165 women (0.6%). The use of general anesthesia for manual removal of placenta decreased from 74% in 19 90 to 19% in 1994. Spinal analgesia was applied from 1993, and it was used in 42% of the women in 1994. Of 74 parous women, 12 (16%) had experienced r etained placenta before. The average difference in the hemoglobin concentra tion between the prenatal and the postoperative values was 3.4 g/dl among t he patients, and 10% required blood transfusion (1-4 units). Among the cont rols, there was no decrease in the average hemoglobin concentration, and on ly 0.5% needed blood transfusion. Endometritis following manual removal was detected in 1.8% of the patients and 1.5% among the controls. Despite manu al removal, five women (3%) were considered to have retained placental frag ments two days or later after delivery, which required curettage. Conclusions. Placenta needed to be removed manually in 0.6% of all deliveri es in our department. It was associated with increased incidence of hemorrh age and consequently low hemoglobin values. Women with a history of retaine d placenta have an increased risk of recurrence of retained placenta in sub sequent deliveries.