• C Wilkinson and M W Enkin.
• Cochrane Db Syst Rev. 2007 Jul 18; 2006 (3): CD000130CD000130.

BackgroundAlthough manual removal of the placenta is commonly carried out, opinions differ about the best technique for delivery of the placenta at caesarean section.ObjectivesThe objective of this review was to assess the effects of manual removal of the placenta at caesarean section.Search StrategyWe searched the Cochrane Pregnancy and Childbirth Group trials register.Selection CriteriaRandomised and quasi-randomised trials comparing manual removal of placenta to spontaneous separation and controlled cord traction for delivery in pregnant women undergoing elective or emergency caesarean section.Data Collection And AnalysisTrial quality assessment and data extraction were done by one reviewer.Main ResultsThree trials involving 224 women were included. The trials were of reasonable quality. Manual removal of the placenta was associated with a clinically important and statistically significant increase in maternal blood loss (weighted mean difference 436.35, 95% confidence interval 347.82 to 524.90). Manual removal was also associated with increased post-partum endometritis (odds ratio 5.44, 95% confidence interval 1.25 to 23.75) and a statistically non-significant trend towards an increase in feto maternal haemorrhage (odds ratio 2.19, 95% confidence interval 0.69 to 6.93).Authors' ConclusionsThe evidence suggests that manual removal of the placenta at caesarean section may do more harm than good, by increasing maternal blood loss and increasing the risk of infection.

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