A clinical review of "Manual removal of placenta" from Jan. 1959 to Dec. 1963 was carried out in Obstetric Dept. of N.M.C. There was a total of 4,393 deliveries with 70 cases in which the placenta was removed manually. In this clinical observation, the author´s attention was particularly directed to the indication, incidence, maternal morbidity, causative factors, relationship between the duration and hemorrhage in 3 ´rd stage and postpartum management.
The results obtained are summerized as follows:
1) The incidence in total deliveries was 1.59% and maternal morbidity was 2.85%, but no case of maternal mortality was seen.
2) Among the 53 cases of multiparas, 62,3% has episodes of abortion in the last pregnancy,, But there was no difference in incidence of manual removal between the spontaneous and < artificial´ abortion.
3) The main indications for manual removal were retention of the placenta more than . half an hour, excessive blood loss (500 cc or more in 3 rd stage) and as the prophylatic measure .after operative delivery.
4) Possible factors for the etiology of retaind placenta and exceesive bleeding were detected in 44.0%, and prematurity was the most predominant causative factor, especially for the retention of the placenta. No placenta accreta was found in this series.
5) Among the total 70 cases of manual removal of placenta, 28.0% lost over 500 cc of blood when the placenta was delivered in 15 minutes, 42.8% when the placenta was removed in 1-2 hours, and 69.6% when the 3 rd stage lasted 2 to hours. All the patients lost over 500cc-if the placenta was retained over 4 hours. Therefore, early removal of retained placenta seemed to reduce both blood loss and danger of infection.
6) Antibiotics was given in 50 cases (70%) prophylatically, mainlyPenicillin and Streptomycin were used for 3-4 days.
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