OBJECTIVE: To determine if hemodynamic compromise can be reduced with manual placental removal at 10 compared with 15 minutes. STUDY DESIGN:Singleton pregnancies admitted for delivery with no contraindication to a vaginal delivery were randomized to a 10-minute group (placentas manually removed if not spontaneously delivered by 10 minutes) versus a 15-minute group. The primary outcome, hemodynamic compromise, was defined as: blood loss exceeding 1000 mL and/or circulatory instability (inability to maintain blood pressure/pulse secondary to acute blood loss) and/or drop in hematocrit of ≥10 percentage points. RESULTS:From July 2006 to July 2010, 156 women were randomized into the 10-minute group and 156 in the 15-minute group. Women in the 15-minute group had a greater likelihood of hemodynamic compromise univariately (19.2% versus 6.4%, p = 0.001) and after adjustments for ethnicity, induction rate, duration of second stage of labor, and nulliparity (relative risk 3.03, 95% confidence interval 1.52 to 5.47, p = 0.002). CONCLUSION:Hemodynamic compromise is decreased with manual placental removal within 10 minutes of delivery compared with 15 minutes. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
RCT Entities:
OBJECTIVE: To determine if hemodynamic compromise can be reduced with manual placental removal at 10 compared with 15 minutes. STUDY DESIGN: Singleton pregnancies admitted for delivery with no contraindication to a vaginal delivery were randomized to a 10-minute group (placentas manually removed if not spontaneously delivered by 10 minutes) versus a 15-minute group. The primary outcome, hemodynamic compromise, was defined as: blood loss exceeding 1000 mL and/or circulatory instability (inability to maintain blood pressure/pulse secondary to acute blood loss) and/or drop in hematocrit of ≥10 percentage points. RESULTS: From July 2006 to July 2010, 156 women were randomized into the 10-minute group and 156 in the 15-minute group. Women in the 15-minute group had a greater likelihood of hemodynamic compromise univariately (19.2% versus 6.4%, p = 0.001) and after adjustments for ethnicity, induction rate, duration of second stage of labor, and nulliparity (relative risk 3.03, 95% confidence interval 1.52 to 5.47, p = 0.002). CONCLUSION: Hemodynamic compromise is decreased with manual placental removal within 10 minutes of delivery compared with 15 minutes. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.