A Maternal Outcome of Spontaneous Delivery versus Manual Delivery of Placenta during Caesarean Section – Prospective Comparative Study: A Tertiary Care Centre in Chengalpattu District

Abstract

Background: Placental delivery during cesarean section can be achieved either by spontaneous physiological separation or manual placental removal. The optimal method remains controversial because of concerns regarding intraoperative blood loss, postoperative haemoglobin decline, and maternal morbidity. This study compared maternal outcomes associated with spontaneous placental delivery and manual placental removal during cesarean section.

Methods: A prospective comparative observational study was conducted in the Department of Obstetrics and Gynaecology, Shri Sathya Sai Medical College and Research Institute, Chengalpattu, Tamil Nadu, from May 2024 to October 2025. Forty-four women undergoing elective or emergency lower segment cesarean section were enrolled using consecutive sampling and allocated into two groups: spontaneous placental delivery (n=22) and manual placental removal (n=22). Baseline demographic and obstetric characteristics were recorded. The primary outcome was intraoperative blood loss. Secondary outcomes included postoperative haemoglobin decline, placental separation time, postoperative hospital stay, blood transfusion requirement, and maternal morbidity. Statistical analysis was performed using SPSS, and a p-value <0.05 was considered statistically significant.

Results: Baseline demographic and clinical characteristics were comparable between the two groups. Mean intraoperative blood loss was significantly lower in the spontaneous placental delivery group than in the manual placental removal group (335.82 ± 117.45 mL vs. 525.32 ± 201.58 mL; p<0.001). The mean postoperative haemoglobin decline was also significantly lower (0.55 ± 0.35 g/dL vs. 0.92 ± 0.62 g/dL; p=0.010). Blood loss exceeding 500 mL occurred in 3.8% of women undergoing spontaneous placental delivery compared with 53.8% in the manual removal group (p<0.001). Although placental separation time was longer with spontaneous placental delivery (8.05 ± 2.40 vs. 6.27 ± 3.10 minutes; p=0.039), postoperative hospital stay, blood transfusion requirement, and maternal morbidity were comparable between the groups.

Conclusion: Spontaneous placental delivery during cesarean section significantly reduces intraoperative blood loss and postoperative haemoglobin decline without increasing maternal morbidity compared with manual placental removal. Despite a slightly longer placental separation time, spontaneous placental delivery appears to be a safer and more physiological approach and may be preferred during cesarean section whenever clinically appropriate.