Zmora I, et al. - Researchers compared women with 3^rd stage of labor removal of placental fragments (3^rd SRPF) n = 3,297 (exposed) and those without n = 97,888 (non exposed) in this 10 years retrospective register-based cohort study of vaginal deliveries to recognize risk factors and complications associated with 3^rd SRPF by manual uterine revision under a strict protocol. Assisted reproductive technologies, preterm delivery, preeclampsia, Multiple previous early pregnancy loss (>3), VBAC and epidural analgesia were the risk factors for 3^rd SRPF procedure. Outcomes revealed significant early and late maternal morbidity in correlation with uterine revision for 3^rd SRPF. Early complications included puerperal fever, blood transfusion, prolonged maternal hospitalization. Late complications comprised significantly higher retained placenta and hysteroscopy / D&C rates compared to controls. Hence they recommend considering 3^rd SRPF as discriminative of a population at risk and postpartum health care planning, beyond being a therapeutic intervention.