Incidence of Post-Cesarean Uterine Infection in relation to Methods of Placental Management

Abstract

Objectives: To study the rate of uterine infection following cesarean delivery with respect to mode of placental delivery and the practice of removal of residual membranes. Material and Methods: In 318 women undergoing elective cesarean delivery grouped based on placental management into four groups, viz., those with manual removal with uterine wiping (n=102), manual removal without uterine wiping (n=65), spontaneous extraction with uterine wiping (n=79), and spontaneous extraction without uterine wiping (n=72; taken as control group)were prospectively studied. The cases were monitored for 7 post-cesarean days for evidence of uterine infection. Uterine infection was considered to be present if at least two of the parameters with one of them being laboratory evidence, were positive. Results: Incidence of uterine infection was (65/ 318 cases, 20.4%).Occurrence of uterine infection did not differ when placenta was managed either manually or not (p=1). Uterine infection was apparently higher when residual membranes were not removed after placental delivery (p=0.4). Proportion of cases with uterine infection appeared to be lower in the group who had manual placental delivery and removal of residual membranes (17.7%) than in manual manual placental removal with no uterine wiping groups (24.6%). And there was no influence of post-placental removal of residual membranes in the cohort with unaided placental delivery (p=0.854). Conclusion: The practices of either manual removal of placenta or uterine wiping to clear the residual placental membranes do not increase the rate of post cesarean uterine infection rate after elective surgeries.