Abstract
Objective: Lack of consensus on when to diagnose and manage retained placenta in the absence of hemorrhage in the 3rd stage of labor, has often subjected Manual removal of placenta (MROP) to the discretion of the accoucher. This study aimed to appraise the practice of manual removal of placenta in a tertiary institution in Nigeria with a view to evaluating risk factors for the procedure and advance probable guidelines to enhance standardization of diagnosis of retained placenta. Design: Case controlled study. Setting: Tertiary maternity center in South west Nigeria. Participants: Data from the hospital records of 92 parturients who had MROP from January to December 2009 were compared with 91 immediate next parturients without MROP matched for age and parity. Variables such as the past obstetric and gynecological history, status of accoucher, gestational age at delivery, duration of 3rd stage, estimated blood loss, quantum of blood transfused and length of hospitalization were extracted and subjected to statistical analysis using the SPSS package. Results: There were 4613 deliveries of which 92 parturients had MROP, an incidence of 1.99%. The mean duration of 3rd stage in the study group was 35.6 ± 18.8 minutes compared to 21.6 ± 6.28 minutes in the control. Doctors were the accoucher in 96.8% of cases while midwives took the deliveries in 84.4% in the control group. Previous scarring of the pregnant uterus such as dilatation and curettage and caesarean section predisposed to MROP compared to the control group (P rd stage of labor with definite criteria for diagnosis of retained placenta to reduce the probable risk of unnecessary MROP.
Highlights
Previous scarring of the pregnant uterus such as dilatation and curettage and caesarean section predisposed to Manual removal of placenta (MROP) compared to the control group (P < 0.032) and (P < 0.024) respectively but there was no significant difference between the two groups with respect to previous myomectomy
Manual Removal of Placenta is a common obstetric procedure performed in the third stage of labor as treatment of the retained placenta when it is undelivered for more than 30 mins, according to the World Health Organization (WHO) [1]
About 15% - 20% of these maternal deaths from post partum hemorrhage are due to retained placenta which will require manual removal of placenta compared with normal delivery of placenta [6,8,9]
Summary
Manual Removal of Placenta is a common obstetric procedure performed in the third stage of labor as treatment of the retained placenta when it is undelivered for more than 30 mins, according to the World Health Organization (WHO) [1]. The choice of timing is a balance between the post-partum hemorrhage risk of leaving the placenta in situ, the likelihood of spontaneous delivery within 60 minutes and the knowledge from caesarean section studies that the manual removal itself causes haemorrhage [4,5]. Retained placenta is a potentially life-threatening condition and a common cause of maternal death from postpartum hemorrhage (PPH) [5,6]. It affects 0.5% - 3.3% of women following vaginal delivery [4,5,7,8]. This study was undertaken to evaluate the incidence of retained placenta, the indications for performing manual removal of retained placenta, assess the risk factors that predisposed parturients to manual removal of placenta and the complications of the procedure with a view to making recommendations
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