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Controlled Cord Traction During the Third Stage of Labor

 

Am Fam Physician. 2016 Mar 1;93(5):online.

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CONTROLLED CORD TRACTION DURING THE THIRD STAGE OF LABOR

Number needed to treat = 114 for postpartum hemorrhage between 500 and 1,000 mL; 161 for manual removal of placenta Number needed to harm = 23 for cord rupture
BenefitsHarms

1 in 114 avoided a postpartum hemorrhage greater than 500 mL but less than 1,000 mL

No severe postpartum hemorrhages (> 1,000 mL) were prevented

1 in 161 avoided the need for manual removal of the placenta

No operations, blood transfusions, or deaths were avoided

1 in 23 had a cord rupture

CONTROLLED CORD TRACTION DURING THE THIRD STAGE OF LABOR

Number needed to treat = 114 for postpartum hemorrhage between 500 and 1,000 mL; 161 for manual removal of placenta Number needed to harm = 23 for cord rupture
BenefitsHarms

1 in 114 avoided a postpartum hemorrhage greater than 500 mL but less than 1,000 mL

No severe postpartum hemorrhages (> 1,000 mL) were prevented

1 in 161 avoided the need for manual removal of the placenta

No operations, blood transfusions, or deaths were avoided

1 in 23 had a cord rupture

Details for This Review

Study Population: Healthy women, 18 years or older, with a single intrauterine pregnancy with imminent vaginal delivery and no contraindication to oxytocin (Pitocin)

Efficacy End Points: Incidence of postpartum hemorrhage; manual removal of the placenta

Harm End Points: Maternal morbidity and mortality; nonprespecified outcomes of uterine inversion and cord rupture

Narrative: The third stage of labor, defined as the time frame between delivery and the complete removal of the placenta, is often actively managed by the delivering physician. One component, controlled cord traction, has been thought to reduce the likelihood of postpartum hemorrhage. This review examined three randomized trials (N = 27,873) of controlled cord traction vs. no controlled cord traction and compared blood loss, duration of third stage of labor, morbidity, and mortality.

The studies demonstrated a reduction in cases of blood loss greater than 500 mL but less than 1,000 mL (number needed to treat [NNT] = 114; relative risk [RR] = 0.93; 95% confidence interval [CI], 0.88 to 0.99) and manual removal of the placenta (NNT = 161; RR = 0.69; 95%

Author disclosure: No relevant financial affiliations.

REFERENCE

1. Hofmeyr GJ, Mshweshwe NT, Gülmezoglu AM. Controlled cord traction for the third stage of labour. Cochrane Database Syst Rev. 2015(1):CD008020.


 

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