Prophylactic antibiotics for manual removal of retained placenta in vaginal birth

We did not identify any trials to say if women with retained placenta after giving birth would benefit from routine antibiotics prior to manual removal of placenta.

Following the birth of her baby, a mother normally delivers the placenta with further pushing and support from her caregivers. Sometimes the placenta gets stuck on the wall of the womb (retained placenta) and does not deliver. These women usually require manual removal of the placenta under anesthesia (either a general or regional). Infection and bleeding are the important complications of manual removal. The review found no trials to determine whether antibiotics given routinely (prophylactically) to all women with retained placenta reduced the incidence of problems. Future trials need to address the risk of contributing to drug resistant bacterial strains.

Authors' conclusions: 

There are no randomized controlled trials to evaluate the effectiveness of antibiotic prophylaxis to prevent endometritis after manual removal of placenta in vaginal birth.

Read the full abstract...

Retained placenta is a potentially life-threatening condition because of its association with postpartum hemorrhage. Manual removal of placenta increases the likelihood of bacterial contamination in the uterine cavity.


To compare the effectiveness and side-effects of routine antibiotic use for manual removal of placenta in vaginal birth in women who received antibiotic prophylaxis and those who did not and to identify the appropriate regimen of antibiotic prophylaxis for this procedure.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2014).

Selection criteria: 

All randomized controlled trials comparing antibiotic prophylaxis and placebo or non antibiotic use to prevent endometritis after manual removal of placenta in vaginal birth.

Data collection and analysis: 

There are no included trials. In future updates, if we identify eligible trials, two review authors will independently assess trial quality and extract data

Main results: 

No studies that met the inclusion criteria were identified.