Background: Although manual removal of the placenta is commonly carried out, opinions differ about the best technique for delivery of the placenta at caesarean section.
Objectives: The objective of this review was to assess the effects of manual removal of the placenta at caesarean section.
Search strategy: We searched the Cochrane Pregnancy and Childbirth Group trials register.
Selection criteria: Randomised 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 analysis: Trial quality assessment and data extraction were done by one reviewer.
Main results: Three 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).
Reviewer's conclusions: The 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.