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Introduction: Postpartum endometritis is 1-8% and cesarean section is one of its risk factor. Thepresent study was performed to compare the effect of manual removal and spontaneous delivery ofplacenta on post-cesarean endometritis and duration of cesarean operation.Materials and Methods: In this prospective (control–case) study, 280 pregnant women undergoingelective cesarean delivery in Shahid Sadoughi (Yezed, Iran) teaching hospital were randomly assignedto two groups: manual placental delivery (140 women) and spontaneous placental delivery (140women). Antibiotic prophylaxis was administered in both groups. The operation time concluded fromskin incision to skin repair. Endometritis was diagnosed in patients who developed clinical signs offever (>38°C) 24 h after delivery, supra-pubic tenderness and vaginal discharge. Data analysis wascarried out using t-test and chi square test by SPSS15.0.Results: The total rate of endometritis was 12.1% (34 women); 12 women in the spontaneousplacental delivery group (8.6%) and 22 women in the manual placental removal group (16%). Thisdifference was statistically significant between two groups (P=0.006). There was no statisticallysignificant difference in duration of operation between two groups (P=0.1).Conclusion: Our finding indicate that manual removal of the placenta increased postpartumendometritis in compared with the spontaneous method of placental removal, but had no influence onthe duration of cesarean.