Background: Delivery by cesarean section is one of the most commonly performed obstetrical operations all over the world, but it exposes women to the inherent risks of major abdominal surgery, e.g., injury to the pelvic structures, infection, and the need for blood transfusion etc. Antepartum physiological adaptation in preparation for blood loss at delivery includes a 42% increase in plasma volume and a 24% increase in red blood cell volume by the third trimester. Objective: The aim of this work was to compare the manual removal of placenta and spontaneous placental delivery combined with cord traction at caesarean section. Patients and Methods: We compare between both groups using computer programs to evaluate the safety and efficacy of each method. Results: There was a significantly higher estimated intraoperative blood loss in women who had their placentae manually separated when compared to women who had spontaneous placental separation. Conclusion: There was a statistically significant drop of hematocrit level in both groups with no statistically significant drop of hemoglobin. In addition, there was increased incidence of endometritis.