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Reducing the Occurrence of Postpartum Hemorrhage: Controlled Cord Traction Vs. Physiologic Management During the 3rd Stage of Labor

10 August 2013


Background: Post partum hemorrhage (PPH) is a major cause of maternal mortality worldwide, accounting for approximately 100 000 deaths annually. It is the most common maternal morbidity in developed countries and accounts for half of all postpartum mortalities in developing countries. The third stage of labor remains the most dangerous for women to endure. It is the time frame between delivery of the fetus and expulsion of the placenta that more complications arise, the most severe of which is post partum hemorrhaging (PPH). It has been scientifically and clinically proven that an active management of the third stage of labor (AMTSL protocol) prevents PPH up to 65%, but it is the purpose of this review to dissect this protocol and determine if the use of controlled cord traction (CCT) has any significant benefit of reducing PPH.

Methods: An exhaustive literature search was conducted using Medline-OVID, CINAHL, EBMR Multifile, Web of Science and utilizing the following search terms: post partum hemorrhage, controlled cord traction, oxytocin and labor stage third. Relevant articles were assessed for quality using GRADE. A search of revealed one currently registered clinical trial, which has not yet been published, as well as a protocol outline for a study that remains in progress.

Results: Three studies met inclusion criteria and were included in this systematic review. A prospective randomized controlled trial with 1648 participants demonstrated a significant difference in PPH when the CCT method was utilized, as opposed to a physiological approach. A randomized, controlled, non-inferiority trial with 12 227 women found that the total loss of blood was less in the CCT group, but did not represent a statistically significant margin. The final study was a randomized, controlled, superiority trial with 103 women participating. Again, blood loss was greater in the physiologically controlled group, but the findings were not statistically significant.

Conclusion: Controlled cord traction, in combination with a complete AMTSL protocol has been shown to reduce the occurrence and subsequent complications of post partum hemorrhage. More specifically, CCT has been attributed to shorter durations of the third stage of labor, which is linked to significant clinical benefit and reduces a plethora of maternal complications. The advantages of this treatment far outweigh the risks in the setting of post partum hemorrhaging. Further research is needed to underscore this finding in a more definitive manner.

Keywords: Controlled cord traction, third stage of labor, human, post partum hemorrhage


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