Influence of Placental Cord Drainage in Management of the Third Stage of Labor: A Multicenter Randomized Controlled Study

Abstract

Objective The aim of this study is to assess the effect of placental drainage during active management of the third stage of labor on reducing both blood loss and the length of the third stage.

Study Design This prospective randomized controlled trial included 485 patients who underwent vaginal delivery in two tertiary hospital. Subjects were randomly allocated to the cord drainage group, in which the cord was unclamped after cutting (n = 242), or the control group, in which the cord was left clamped (n = 243). The primary outcome was mean blood loss during the third and fourth stages of labor.

Results The mean estimated blood loss was significantly lower in the cord drainage group than in the control group (207.04 ± 123.3 vs. 277.63 ± 246.9 mL, respectively; p ˂ 0.001). The third stage of labor was significantly shorter in the cord drainage group than in the control group (3.5 ± 1.9 vs. 7.7 ± 3.4 minutes, respectively; p ˂ 0.001). No adverse events occurred during the cord drainage period.

Conclusion Active management of the third stage of labor with the cord drainage method significantly reduced postpartum blood loss and the duration of the third stage.

Keywords

drainage - cord - stage - delivery

• References

• 1 The Woman (World Maternal Antifibrinolytic) Trial. Tranexamic asid for the treatment of postpartum hemorrhage: An international, double blind, randomized, placebo controlled trial. London: United Kingdom; 2009
• 2 Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü ICON-INSTITUT Public Sector GmbH ve BNB Danışmanlık. Ulusal Anne Ölümleri Çalışması, 2005. Sağlık Bakanlığı Ana Çocuk Sağlığı ve Aile Planlaması Genel Müdürlüğü ve Avrupa Komisyonu Türkiye Delegasyonu, Ankara, Turkey; 2006
• 3 World Health Organization. The prevention and management of postpartum haemorrhage. Report of a technical working group. Geneva (Switzerland): WHO; 1990
• 4 Carroli G, Cuesta C, Abalos E, Gulmezoglu AM. Epidemiology of postpartum haemorrhage: a systematic review. Best Pract Res Clin Obstet Gynaecol 2008; 22 (6) 999-1012
• 5 Fullerton G, Danielian PJ, Bhattacharya S. Outcomes of pregnancy following postpartum haemorrhage. BJOG 2013; 120 (5) 621-627
• 6 World Health Organization. The prevention and management of postpartum haemorrhage. Report of a technical working group. Geneva, Switzerland: WHO; 2012
• 7 Weeks AD. The retained placenta. Best Pract Res Clin Obstet Gynaecol 2008; 22 (6) 1103-1117
• 8 Begley CM, Gyte GML, Devane D, McGuire W, Weeks A. Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev 2011; 9 (11) CD007412
• 9 International Federation of Obstetrics and Gynaecology; International Confederation of Midwives. International joint policy statement. FIGO/ICM global initiative to prevent post-partum hemorrhage. J Obstet Gynaecol Can 2004; 26 (12) 1100-1102
• 10 World Health Organization. WHO recommendations for the prevention of postpartum hemorrhage. 2007 . Available at: http://www.who.int/maternal_child_adolescent/documents/who_mps_0706/en/ . Accessed September 12, 2012
• 11 Sharma JB, Pundir P, Malhotra M, Arora R. Evaluation of placental drainage as a method of placental delivery in vaginal deliveries. Arch Gynecol Obstet 2005; 271 (4) 343-345
• 12 Shravage JC, Silpa P. Randomized controlled trial of placental blood drainage for the prevention of postpartum hemorrhage. J Obstet Gynaecol India 2007; 57 (5) 213-215
• 13 Jongkolsiri P, Manotaya S. Placental cord drainage and the effect on the duration of third stage labour, a randomized controlled trial. J Med Assoc Thai 2009; 92 (4) 457-460
• 14 Soltani H, Poulose TA, Hutchon DR. Placental cord drainage after vaginal delivery as part of the management of the third stage of labour. Cochrane Database Syst Rev 2011; (9) CD004665
• 15 Shmukler M. Density of blood. In: Elert G, ed. The physics factbook. An encyclopedia of scientific essays. Available at: http://hypertextbook.com/facts/2004/MichaelShmukler.shtml Retrieved May 5, 2009
• 16 Sekhavat L, Firuzabadi RD, Karimi Zarchi M. Effect of postpartum oxygen inhalation on vaginal blood loss. J Matern Fetal Neonatal Med 2009; 22 (11) 1072-1076
• 17 Giacalone PL, Vignal J, Daures JP, Boulot P, Hedon B, Laffargue F. A randomised evaluation of two techniques of management of the third stage of labour in women at low risk of postpartum haemorrhage. BJOG 2000; 107 (3) 396-400
• 18 Navaneethakrishnan R, Anderson A, Holding S, Atkinson C, Lindow SW. A randomised controlled trial of placental cord drainage to reduce feto-maternal transfusion. Eur J Obstet Gynecol Reprod Biol 2010; 149 (1) 27-30