Manual removal versus spontaneous delivery of the placenta at caesarean section: a randomized controlled trial by Abdelfattah et al: a letter to the editor

I highly admire the article “Abdelfattah LE, Bastawy AMA, Fahmy MSED. Manual removal versus spontaneous delivery of the placenta at caesarean section: a randomized controlled trial in International journal of reproduction, contraception, obstetrics and gynecology”.1 Really there is dearth of randomized control trials (RCTs) on this issue of managing third stage of labour during caesarean section, and this is making obstetricians to continue practicing MRP (manual removal of placenta) during caesarean section.2 The general reason for MRP at caesarean section is to save time of surgical procedure of caesarean section. The authors of this article have rightly pointed out by RCT that this does not save time and in fact add many other complications to the outcome of caesarean section surgery

Caesarean delivery on maternal request: need to redefine in view of intrapartum cases

Background: The objective of the study was to analyse the data of caesarean section on maternal request (CDMR) both before labour and intrapartum, in low-income society from a town in India.Methods: It was a retrospective observational study of 9331 caesarean section (CS) cases carried out in different small private maternity hospitals over a period of 20 years. We used the data for auditing the CS cases done on maternal request.Results: Out of 9331 CS cases documented, 216 CS were done on maternal request. The incidence of CDMR was 2.31%. About one third cases were intra-partum. The rising trend of CDMR was observed both before labour and intra-partum.Conclusions: There was a need to redefine CDMR in the view of rise in the incidence of women requesting for CS not only before labour but during lab or also. CDMR is no more confined to highly educated, rich and women from urban area. Less educated, low income group women residing in rural area are also becoming aware that CS can be done on maternal request.

Caesarean section scar pregnancy: case report, literature review and illustrative images

A case report of exogenic caesarean section scar pregnancy which ruptured into the utero-vesical pouch causing hemoperitoneum is presented with very illustrative images. Literature regarding importance of early diagnosis of caesarean scar pregnancy is reviewed