How can methods of placental delivery in cesarean section affect perioperative blood loss? A randomized controlled trial of controlled cord traction versus manual removal of placenta.

Aim: Of the different described methods of placental delivery during cesarean section (CS), manual removal and cord traction are the most commonly used techniques. The ideal method of placental delivery during CS is still a conflicting issue as the data derived from the previous studies are widely heterogeneous and inconsistent. This study has investigated the effect of two different methods of placental delivery, controlled cord traction and manual removal, on perioperative blood loss.

Methods: This randomized controlled trial recruited 345 pregnant women scheduled for elective cesarean delivery at term. Eligible participants were randomly assigned to have their placentae delivered either by manual removal or cord traction. Perioperative blood loss was the study primary outcome measure.

Results: A total of 300 women were included in the final analysis. The longer placental delivery time in the cord traction group (n = 150) (60 s. [45-61.25] versus 45 s. [35-60] in the manual placental delivery group, P < 0.001) was associated with a statistically significant but clinically insignificant higher visually estimated blood loss (500 mL [interquartile range, 500-700] versus 500 mL [interquartile range, 400-500] in the manual removal group, P < 0.001). Although there were statistically significant differences in the hemoglobin levels, postoperatively, these differences were clinically insignificant and were not reflected in the corresponding deficits and percentages of deficit at 12- and 48-h postoperative intervals.

Conclusions: Of the studied placental delivery techniques, there were no clinically significant differences in terms of the considered intraoperative and postoperative outcomes; hence, the practice of placental delivery can be left up to obstetrician's discretion and intraoperative scenario.