In Caesarean deliveries the placenta is usually removed by hand or by a technique known as 'cord traction'. A recent systematic review by Cochrane Researchers shows that cord traction poses less risk to the mother than manual removal.
Removal of the placenta in Caesarean births may affect a woman's chance of complications such as endometritis (infection of lining of the womb) and post-operative bleeding. One possible cause of endometritis is that bacteria on the surgeon's gloves are carried into the womb during manual removal of the placenta. In cord traction, the surgeon's hand doesn't enter the womb. Instead the woman is given oxytocin and external massage, which detach the placenta and it is then pulled from the womb by gentle traction on the umbilical cord.
The new study compares the advantages of the two techniques. Researchers reviewed 15 trials involving a total of 4,694 women and found that there was an increased risk of endometritis and high blood loss in caesareans where the placenta was removed by hand. Women who had manual removal also stayed in hospital longer after their operations.
"Although cord traction may take a little bit longer, there are clear health benefits of this method over manual removal of the placenta," says lead researcher Rose Anorlu, a gynaecologist at the College of Medicine of the University of Lagos in Nigeria.