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Postpartum hemorrhage is the leading cause of maternal deaths in all over the world, especially in developing and underdeveloped countries. Medical and surgical methods exist for management of bleeding.
There are two surgical techniques for removal of the placenta on cesarean delivery, which are called manual removal and controlled cord traction. In manual removal group, the duration of surgery time might be shorter theoretically. Nevertheless, there are studies showing that manual removal of the placenta may increase postpartum endometritis and postpartum hemorrhage. The optimal method for removal of the placenta during the cesarean delivery remains uncertain (1).
It is a known fact that uterine massage after vaginal birth lowers the risk of postpartum hemorrhage (2) However, there is no study on how effective uterine massage is during cesarean delivery. In 2018, Saccone and colleagues wanted to publish a meta-analysis on the role of uterine massage in reducing postpartum bleeding during cesarean delivery, but when they examined the literature on the subject, they could not find a study which included only the group that gave birth by cesarean section and was free from bias. In the same publication, it was mentioned that it was necessary to investigate the effectiveness of uterine massage, which is a cost-free method that can reduce maternal morbidity in underdeveloped countries where maternal deaths due to postpartum bleeding are high, in cesarean section. (3)
In this study, data of patients who underwent emergency cesarean delivery in the Department of Obstetrics and Gynecology, Ankara Etlik City Hospital, will be collected
The parameters to be examined in the research are as follows:
The sample size of this study was calculated with the Gpower3.1 computer program.
The total number of samples with 90% power and 95% confidence interval was calculated as 338 patients. The number of volunteers to participate in our study is planned to be 360 in total, 60 volunteers for each group, across 6 groups. Results will be considered statistically significant for p< 0,05.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group 1- | Operation will be performed by Dr BL
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| Group 2 | Operation will be performed by Dr AC
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| Group 3 | Operation will be performed by Dr SM
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| Group 4 | Operation will be performed by Dr AS
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Manual Removal 1 | Procedure |
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| Measure | Description | Time Frame |
|---|---|---|
| Comparison of patients' preoperative and postoperative hemoglobin levels | The basal hemoglobin levels ( gr/dL) of the patients will be compared with the hemoglobin levels at 2nd, 6th and 24th hours. | 24 hours |
| Comparison of patients' preoperative and postoperative hematocrit levels | The basal hematocrit levels (%) of the patients will be compared with the hematocrit levels at 2nd, 6th and 24th hours | 24 hours |
| Comparison of patients' postoperative shock indexes | Postoperative 30th minute, 1st and 2nd hour shock indices (heart rate (beats per minute) / systolic blood pressure(mmHg) ) will be compared | 2 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Comparison of the patients' postoperative heart rate | Patients postoperative 30th minute, 1st and 2nd hour heart rate (beats in minute) will be compared | 2 hours |
| Comparison of the patients' postoperative systolic and diastolic blood pressure |
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Inclusion Criteria:
Exclusion Criteria:
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In our study, data of patients who underwent emergency cesarean delivery at the Department of Obstetrics and Gynecology, Ankara Etlik City Hospital, will be collected prospectively
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| sumeyye sarıtas | Contact | +903122790000 | etliksh.iletisim@saglik.gov.tr |
| Name | Affiliation | Role |
|---|---|---|
| Busra Lekesiz | Ankara Etlik City Hospital | Principal Investigator |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 18646109 | Background | Anorlu RI, Maholwana B, Hofmeyr GJ. Methods of delivering the placenta at caesarean section. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD004737. doi: 10.1002/14651858.CD004737.pub2. | |
| 23818022 | Background | Hofmeyr GJ, Abdel-Aleem H, Abdel-Aleem MA. Uterine massage for preventing postpartum haemorrhage. Cochrane Database Syst Rev. 2013 Jul 1;2013(7):CD006431. doi: 10.1002/14651858.CD006431.pub3. |
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| Group 5 | Operation will be performed by Dr EDD
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| Group 6 | Operation will be performed by Dr SKE
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| Manual Removal 2 | Procedure |
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| Controlled Cord Traction 1 | Procedure |
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| Controlled Cord Traction 2 | Procedure |
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| Controlled Cord Traction+Uterine Massage 1 | Procedure |
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| Controlled Cord Traction+Uterine Massage 2 | Procedure |
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Patients postoperative 30th minute, 1st and 2nd hour systolic and diastolic blood pressure (mmHg) will be compared
| 2 hours |
| 29499526 | Background | Saccone G, Caissutti C, Ciardulli A, Berghella V. Uterine massage for preventing postpartum hemorrhage at cesarean delivery: Which evidence? Eur J Obstet Gynecol Reprod Biol. 2018 Apr;223:64-67. doi: 10.1016/j.ejogrb.2018.02.023. Epub 2018 Feb 23. |
| ID | Term |
|---|---|
| D006473 | Postpartum Hemorrhage |
| D014593 | Uterine Inertia |
| D006470 | Hemorrhage |
| ID | Term |
|---|---|
| D007744 | Obstetric Labor Complications |
| D011248 | Pregnancy Complications |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D011644 | Puerperal Disorders |
| D014592 | Uterine Hemorrhage |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D004420 | Dystocia |
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