Department of Obstetrics and Gynecology, Menoufia University Hospital, Menoufia, Egypt.
Department of Obstetrics and Gynecology, El Kabbari Central Hospital, Behira, Egypt.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):5199-5203. doi: 10.1080/14767058.2021.1875442. Epub 2021 Apr 11.
to assess the impact of manual removal of the placenta and intrauterine cleaning during elective cesarean delivery on maternal infectious morbidity and blood loss.
This prospective multicenter trial was conducted on 436 pregnant women at term who were intended for elective cesarean delivery and allocated into four groups; group 1 ( = 110) who underwent manual removal of the placenta with intrauterine cleaning, group 2 ( = 106) who underwent manual removal of the placenta without intrauterine cleaning, group 3 ( = 108) who underwent spontaneous placental delivery with intrauterine cleaning and group 4 ( = 112) who underwent spontaneous placental delivery without intrauterine cleaning. Maternal operative blood loss, the rate of endometritis and surgical site infections (SSIs) was assessed and recorded.
There was no significant difference between the four groups regarding drop of hemoglobin concentration, drop of hematocrit value, re-operation, re-admission to hospital, duration of hospital stay, the rate of endometritis and SSIs as well as maternal acceptability in terms of overall discomfort, overall satisfaction with delivery and recommendation to other women ( > .05). Intrauterine cleaning was associated with a significantly shorter duration of discharge of lochia and rapid return to daily activity compared to non-intrauterine cleaning ( < .05).
Manual removal of the placenta and intrauterine cleaning have no deleterious impact on maternal blood loss and infectious morbidity after elective cesarean section. Also, intrauterine cleaning was associated with faster cessation of lochia and faster return to daily activity.
评估在择期剖宫产术中手动剥离胎盘和宫腔清理对产妇感染发病率和出血量的影响。
这项前瞻性多中心试验纳入了 436 名足月计划行择期剖宫产的孕妇，将其分为四组；组 1（n=110）行手动剥离胎盘伴宫腔清理，组 2（n=106）行手动剥离胎盘不伴宫腔清理，组 3（n=108）行自然胎盘娩出伴宫腔清理，组 4（n=112）行自然胎盘娩出不伴宫腔清理。评估并记录产妇术中出血量、子宫内膜炎和手术部位感染（SSI）的发生率。
四组间血红蛋白浓度下降、血细胞比容值下降、再次手术、再次住院、住院时间、子宫内膜炎和 SSI 的发生率以及产妇对总体不适、分娩总体满意度和向其他女性推荐的接受程度无显著差异（>0.05）。与非宫腔清理相比，宫腔清理与恶露排出时间明显缩短，日常活动恢复更快（<0.05）。
在择期剖宫产术中，手动剥离胎盘和宫腔清理对产妇出血量和感染发病率没有不良影响。此外，宫腔清理与恶露更快停止和更快恢复日常活动相关。
