The Effect of the Method of Placental Delivery and Site of Uterine Closure on Intra-operative Blood Loss and Postpartum Endometritis

Abstract

Background: Some of the short term morbidities in caesarean section include hemorrhage, post operative fever and endometritis and caesarean is the most common major operation performed worldwide on women, still there is no universally accepted procedure for management of placental delivery after caesarean section, whether to clear the uterine cavity or not for the residual membranes and whether to close the uterine incision by exteriorization or intraperitoneally. Taking all this into consideration this study was aimed at looking for the best method of practice in one of the most common operations in Obstetrics in this era. Methods: After extraction of the baby the placenta was removed either manually or delivered spontaneously and to wipe the uterine cavity with a mop was left to the decision of the operating surgeon and closure of the uterine incision (intraperitoneal or exteriorization) was done according to the convenience of the surgeon. The following outcomes were studied based upon the above operative techniques- intra operative blood loss & post operative endometritis. Results: The average blood loss in spontaneous delivery of placenta was 319.30±104.1 ml and in manual removal of placenta it was 346.63±111.7 ml. Uterine incision was closed extraperitoneally in 61 cases with an average blood loss of 291.03±98.9 ml and in 42 cases of intraperitoneal uterine closure the average blood loss was 396.79±91.1 ml with a significant p value of <0.0001. Conclusion: Spontaneous delivery of placenta along with closing the uterine incision by exteriorizing the uterus has minimal blood loss. By knowing this, caesarean sections, one of the most common operations in obstetric practice can be made as safe as possible.