PLD.18 Recurrence rate of Manual Removal of Placenta and associated Postpartum Haemorrhage

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Abstract

Introduction

Recurrence rate of retained placenta requiring manual removal of placenta (MROP) varies in the reported literature. NICE guidance suggests birth at an obstetric unit for women who have previously had MROP. However, some women do give birth at home or at midwife-led units and may require emergency transfer to obstetric units for recurrent retained placenta.

Aim

To investigate the recurrence rate of MROP and associated postpartum haemorrhage (PPH).

Method

Women who had MROP and subsequent pregnancies at St. Michael’s Hospital over a ten year period (2002–2012) were identified using maternity databases. Caesarean births were excluded as the threshold for performing MROP is lower and any future deliveries would be managed in an obstetric-led unit.

Results

Of the 46,697 births during this period, 282 women had MROP and a subsequent pregnancy. 17.7% (50 women) had recurrent MROP. Incidence of PPH (>500 ml) was 11.7% and of major haemorrhage (>1000 ml) was 4.2%. The incidence of major haemorrhage was lower (2.7%) in women who did not have a major haemorrhage in the index pregnancy and was much lower (0.7%) in women who lost less than 500ml in the index pregnancy.

Conclusions

The recurrence rate of retained placenta leading to MROP is high but the incidence of associated major haemorrhage is lower, especially in women who did not have PPH in the index pregnancy. This data should help inform patients and healthcare professionals when selecting optimal place of birth in subsequent pregnancies.

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