Musarrat Shaheen, Saira Khurshid, Muhammad Asghar.
Blood loss in manual extraction of placenta versus spontaneous delivery during elective cesarean section.
Gomal J Med Sci Jan ;12(3):168-71.

Background: Excessive bleeding is one of the major threats to women at childbirth. Blood loss during cesarean section is usually underestimated. The objective of this study was to compare the effects of manual extraction of placenta versus spontaneous delivery on blood loss during elective cesarean section. Material & Methods: This comparative cross-sectional study was conducted in Department of Gynecology and Obstetrics, Military Hospital Rawalpindi from December 2009 to June 2010. Eighty-four patients were divided in two groups. In Group A placenta was delivered spontaneously by umbilical cord traction method and in Group B it was extracted manually. The hemoglobin concentration was estimated before cesarean section and 24 hours post-operatively. A drop in hemoglobin concentration of more than 2 g/dl was considered as significant blood loss. The significant blood loss of the two groups was compared using Chi-square test. Results: The mean age in Group A was 24.5+1.92 years and in Group B 23.95+2.06 years. The mean drop in hemoglobin in Group A was 1.25+0.52 g/dl and in group B (1.86+0.66) g/dl. In Group A five (11.9%) patients had significant drop in hemoglobin and in Group B it was in 12 (28.57%) patients (p=0.02). Conclusion: Manual removal of placenta during cesarean section is associated with more blood loss as com¬pared to spontaneous removal by umbilical cord traction.

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