The association between manual removal of the placenta and postpartum endometritis following vaginal delivery

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Abstract
To determine whether manual removal of the placenta after vaginal delivery is a risk factor for postpartum endometritis. A retrospective cohort study of vaginal deliveries compared 1052 patients who had manual removal of the placenta with 1085 patients whose placentas delivered spontaneously. Subjects were selected randomly from the 25,687 vaginal deliveries at the University of Iowa Hospitals during 1979-1992. The presence of endometritis was determined using information in medical records. The data were analyzed using odds ratios (OR) and multiple logistic regression. After controlling for confounding variables, manual removal of the placenta was associated with postpartum endometritis (adjusted OR 2.9, 95% confidence interval [CI] 1.7–4.9). Other risk factors for endometritis included maternal age less than 17 years (OR 3.3, 95% CI 1.5–7.2), postpartum anemia (OR 2.9, 95% CI 1.9–4.5), and membranes ruptured longer than 24 hours (OR 2.5, 95% CI 1.4–4.3). Manual removal of the placenta is a risk factor for postpartum endometritis after vaginal delivery.

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