Active management of the third stage of labor with and without controlled cord traction

摘要

The most important risk factors for postpartum hemorrhage (PPH) are anemia, pre-edampsia, previous PPH, grand multiparity, twins, and elongation of the third stage of labor. It has been shown that active management of the third stage of labor (AMTSL) reduces blood loss by more than 1000mL compared with expectant management [ 1 ]. According to WHO recommendations [2], AMTSL provided by skilled birth attendants should be offered to all women for the prevention of PPH. However, there is currently insufficient evidence of the effectiveness of controlled cord traction (CCT) in AMTSL [3], Controlled cord traction is a component that requires skilled manual training in order to be performed appropriately [4]. The aim of the present study was to determine the effectiveness of CCT in AMTSL A hospital-based, individually randomized study was conducted at the Kemerovo Regional Clinic Perinatal Center, Kemerovo, Russia. The study design was approved by the Ethics Committee of the Kemerovo State Medical Academy, and informed consent was signed by each patient Between March 26 and October 8, 2011, 1095 women with planned vaginal births were randomly assigned to a management group for the third stage of labor: 540 to the full package group (group 1: intramuscular uterotonic injection [oxytocin 10 IU] during the first minute after delivery of the infant, CCT, and uterine massage after delivery of the placenta) and 555 to the simplified package group (group 2: intramuscular uterotonic injection [oxytocin 10 IU] during the first minute after delivery of the infant and uterine massage after delivery of the placenta). Randomization was conducted via calendar method (full package performed on even dates, simplified package performed on odd dates). After the exclusion of women who underwent emergency cesarean delivery and forceps/vacuum extraction, 400 women remained in each group.