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Placenta removal after C-section: wait 5 minutes. (Spontaneous Delivery Urged).
SAN FRANCISCO -- Waiting 5 minutes to allow spontaneous delivery of the placenta after cesarean delivery reduces the risk of significant blood loss, compared with manual removal of the placenta, Dr. Michel Ange Morales reported at the annual meeting of the Society for MaternalFetal Medicine.
That finding emerged from a multi-center, prospective, randomized comparison of the two techniques in 427 women undergoing elective or non-elective C-sections at more than 34 weeks' gestation.
By the third day after surgery, 13% of women given a chance to deliver the placenta spontaneously and 21% of women in whom the placenta was delivered manually had a fall in hemoglobin greater than 25 g/L by the third day after surgery, In the United States, ob.gyns. usually remove the placenta manually after cesarean delivery. At Dr. Morales' institution, the University of Geneva, manually removing the placenta and cleaning the uterus after C-section had been the standard practice, but the study results prompted a policy change favoring spontaneous placental delivery.
Approximately seven published studies have compared the effects of spontaneous delivery of the placenta with manual detachment, evaluating maternal bleeding, postoperative infection, and maternal transfusion after C-section. These studies produced conflicting results, and controversy over the best management approach led to the current study
In the spontaneous delivery group, surgeons waited up to 10 minutes with no systematic manual exploration of the uterine cavity. If the patient started bleeding excessively or didn't deliver all of the placenta within that time, the placenta was manually removed from the uterus.
In the manual removal group, surgeons cleaned out the placenta shortly after delivering the neonate. In the ...
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Source: HighBeam Research, Placenta removal after C-section: wait 5 minutes. (Spontaneous...