الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Caesarean section (CS) is an important lifesaving operation for both mother and child, and its use has increased dramatically over the last decade. (6) The placenta is a vital organ with multiple functions, such as endocrine, immune, and physiological. (1) CS rates in Egypt have steadily increased, reaching 52% of all deliveries according to the most recent 2014 Egypt Demographic and Health Survey (EDHS) and representing more than a 100% increase in the CS rate since 2005. (7) It is potentially associated with morbidities: bleeding, postoperative fever and endometritis, venous thromboembolism and abnormal placentation in the subsequent pregnancies. The risk of hemorrhage is higher for women undergoing cesarean delivery compared to vaginal delivery. (8) (9) This is a prospective comparative interventional study, conducted on 196 pregnant women with singleton uncomplicated pregnancies who attended to the outpatient antenatal clinic and scheduled for elective delivery by CS at term in Menoufia University Hospital and Itay-Elbarod General Hospital. They were divided into two groups: group (A): consists of 98 women in which manual removal of placenta with intrauterine cleaning with gauze pads was done. group (B): consists of 98 women in which spontaneous separation of placenta without intrauterine cleaning was done. After giving an informed consent, all included pregnant women were subjected to: Full history taking including present history, past history of medical disorders, surgical or gynecological operations, obstetric history. General examination: Vital signs and symptoms: focusing on blood pressure, temperature, respiratory rate and patients’ texture (to exclude chorioamnioinitis). Obstetric ultrasonography: ultrasound examination was done for assessment of gestational age, exclusion of congenital anomalies and estimation of amniotic fluid index.
Laboratory Investigations: ABO, Rh, CBC, PT, PTT, INR, ALT, AST, RBS, Urine analysis, Blood urea, Serum creatinine, Serum uric acid. Then elective CS were done to all patients by the same team and after placental delivery for each group 10 units of oxytocin were placed in 500 cc of ringer lactate and infused over 4h .
The postoperative management plan was also similar for all women, including: early ambulation, intravenous fluids, measurement of vital data, thromboprophylaxis, oral intake and repeat complete blood count (CBC) within 24h. Follow up till week postoperative: Body temperature.
Vaginal discharge (color, odor). Wound healing (healthy or non-healthy).
Our study resulted in that there is no significant difference between two methods. There were no statistically differences between the two groups concerning: postoperative Hg%, postoperative Hg drop, duration of whole CS procedure, hospital stay, need for additional ecbolic and the need for blood transfusion intra or postoperative