Manual Removal versus Spontaneous Delivery of the Placenta at Cesarean Section: A Meta-Analysis of Randomized Controlled Trials

Meng-Chang Yang; Peng Li; Wen-Jie Su; Rong Jiang; Jia Deng; Ru-Rong Wang; Chao-Li Huang

doi:10.2147/TCRM.S333557

Manual Removal versus Spontaneous Delivery of the Placenta at Cesarean Section: A Meta-Analysis of Randomized Controlled Trials

Ther Clin Risk Manag. 2021 Dec 2:17:1283-1293. doi: 10.2147/TCRM.S333557. eCollection 2021.

Authors

Meng-Chang Yang^#¹, Peng Li^#¹, Wen-Jie Su¹, Rong Jiang¹, Jia Deng¹, Ru-Rong Wang², Chao-Li Huang³

Affiliations

¹ Department of Anesthesiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, People's Republic of China.
² Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
³ Department of Internal Medicine, Eastern Hospital, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: Several randomized clinical trials (RCTs) investigated the effects of the manual placental removal on hemorrhage or other hemorrhage-related complications compared with the spontaneous placental removal during cesarean section (CS), while the results remained controversial and were inconsistent. The purpose of this meta-analysis was to quantify the pooled effects of the methods of placental removal on hemorrhage during CS.

Patients and methods: A systematic literature search was conducted using PubMed, EMBASE, Web of Science, and Google Scholar. Heterogeneity was tested by I ² statistics and Q-statistic. The random-effects model or fixed-effects model were used to calculate the pooled effect for the included studies according to heterogeneity. And the term of standardized mean difference (SMD) with 95% confidence intervals (CI) was pooled and estimated the effects across all studies.

Results: A total of nine RCTs were included in this meta-analysis. Compared with spontaneous group, manual placental removal increased the amount of hemorrhage (SMD = 0.53, 95% CI [0.12, 0.94]; Z = 2.54, P = 0.011) and increased the risk of endometritis (OR = 1.84, 95% CI [1.31, 2.58]; Z = 3.52, P < 0.0001). In contrast, there was no significant difference concerning the operating time (SMD = -0.30, 95% CI [-0.85, 0.24]; Z = 1.09, P = 0.276), the length of hospital stays (SMD = 0.11, 95% CI [-0.08, 0.30]; Z = 1.11, P = 0.265), and blood transfusion requirement (OR = 1.36, 95% CI [0.91, 2.04]; Z = 1.52, P = 0.129), respectively.

Conclusion: Comparing with spontaneous placental removal, manual placental removal appeared to be less positive effect during CS. Because of the limitations of this meta-analysis, more high-quality RCTs are needed to confirm our findings.

Keywords: cesarean section; hemorrhage; manual placental removal; meta-analysis; spontaneous placenta removal.

Grants and funding

This research was supported by the China International Medical Foundation (NO: 30320200051) and the Key Fund Project of Sichuan Provincial Department of science and technology (NO: 30504010469).