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Background <p>Retained placenta is a significant cause of postpartum hemorrhage (PPH) and maternal morbidity. Despite its clinical importance, limited data exists on the safety and effectiveness of different anesthetic techniques for manual removal of placenta (MROP). This study aimed to assess anesthesia-related outcomes and complications in a large tertiary care center with 20,000 to 22,000 annual deliveries.</p> Methods <p>A retrospective cohort study was conducted on women who underwent MROP in the operating room between January 2018 and September 2024. Institutional Review Board approval was obtained prior to data collection. Patient demographics, risk factors, anesthetic techniques, and clinical outcomes were collected and analyzed.</p> Results <p>During the study period, there were 130,338 vaginal deliveries at our institution. Among 1,366 women (1.05%) undergoing MROP, 860 required placental revision and 506 underwent manual placental removal. Vacuum-assisted delivery was performed in 99 cases (22%). Neuraxial anesthesia was the predominant modality (81.9%), with spinal anesthesia most frequently used (73.7%) and 25.7% subsequently converted to epidural anesthesia. General anesthesia (GA) (16.6%) and sedation (1.5%) were less commonly employed. Women receiving GA had significantly higher risks of blood transfusion (RR 6.0 for RBC, RR 19.5 for FFP, <i>p</i> &lt; 0.0001), longer hospitalization (4.1 ± 2.3 vs. 3.5 ± 3.4 days, <i>p</i> &lt; 0.002), and increased need for ICU/PACU monitoring (RR 20.9, <i>p</i> &lt; 0.0001). Difficult intubation occurred in three cases, with one reported case of aspiration. No hysterectomies were required.</p> Conclusions <p>Neuraxial anesthesia was the preferred method for MROP, demonstrating a low failure rate. In contrast, GA was associated with increased morbidity, including higher transfusion requirements, prolonged hospitalization, and greater need for intensive monitoring. The occurrence of airway complications in GA cases underscores the importance of optimizing anesthetic management. Minimizing the use of GA, when feasible, may contribute to improved patient outcomes in MROP procedures.</p>

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Anesthetic strategies for manual removal of retained placenta: an observational cohort study at a university referral center

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月11日

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  • Mohamad Yousef,
  • Daniel Shatalin,
  • Tehila Avitan,
  • Yaacov Gozal,
  • Yair Binyamin,
  • Alexander Ronenson,
  • Alexander Ioscovich

摘要

Background

Retained placenta is a significant cause of postpartum hemorrhage (PPH) and maternal morbidity. Despite its clinical importance, limited data exists on the safety and effectiveness of different anesthetic techniques for manual removal of placenta (MROP). This study aimed to assess anesthesia-related outcomes and complications in a large tertiary care center with 20,000 to 22,000 annual deliveries.

Methods

A retrospective cohort study was conducted on women who underwent MROP in the operating room between January 2018 and September 2024. Institutional Review Board approval was obtained prior to data collection. Patient demographics, risk factors, anesthetic techniques, and clinical outcomes were collected and analyzed.

Results

During the study period, there were 130,338 vaginal deliveries at our institution. Among 1,366 women (1.05%) undergoing MROP, 860 required placental revision and 506 underwent manual placental removal. Vacuum-assisted delivery was performed in 99 cases (22%). Neuraxial anesthesia was the predominant modality (81.9%), with spinal anesthesia most frequently used (73.7%) and 25.7% subsequently converted to epidural anesthesia. General anesthesia (GA) (16.6%) and sedation (1.5%) were less commonly employed. Women receiving GA had significantly higher risks of blood transfusion (RR 6.0 for RBC, RR 19.5 for FFP, p < 0.0001), longer hospitalization (4.1 ± 2.3 vs. 3.5 ± 3.4 days, p < 0.002), and increased need for ICU/PACU monitoring (RR 20.9, p < 0.0001). Difficult intubation occurred in three cases, with one reported case of aspiration. No hysterectomies were required.

Conclusions

Neuraxial anesthesia was the preferred method for MROP, demonstrating a low failure rate. In contrast, GA was associated with increased morbidity, including higher transfusion requirements, prolonged hospitalization, and greater need for intensive monitoring. The occurrence of airway complications in GA cases underscores the importance of optimizing anesthetic management. Minimizing the use of GA, when feasible, may contribute to improved patient outcomes in MROP procedures.