Placental cord drainage after vaginal delivery as part of the management of the third stage of labour

Abstract

Background: Cord drainage in the third stage of labour involves unclamping the previously clamped and divided umbilical cord and allowing the blood from the placenta to drain freely into an appropriate receptacle.

Objectives: The objective of this review was to assess the specific effects of placental cord drainage on the third stage of labour following vaginal birth, with or without prophylactic use of uterotonics in the management of the third stage of labour.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (February 2010).

Selection criteria: Randomised controlled trials comparing placental cord draining with no placental cord drainage as part of the management of the third stage of labour.

Data collection and analysis: Two review authors independently assessed the quality of trials and extracted data. This was then verified by the third review author who then entered the agreed outcomes to the review.

Main results: Three studies involving 1257 women met our inclusion criteria. Cord drainage reduced the length of the third stage of labour (mean difference (MD) -2.85 minutes, 95% confidence interval (CI) -4.04 to -1.66; three trials, 1257 women (heterogeneity: T² = 0.87; Chi²P=17.19, I² = 88%)) and reduced the average amount of blood loss (MD -77.00 ml, 95% CI -113.73 to -40.27; one trial, 200 women).No incidence of retained placenta at 30 minutes after birth was observed in the included studies, therefore, it was not possible to compare this outcome. The differences between the cord drainage and the control group were not statistically significant for postpartum haemorrhage or manual removal of the placenta. None of the included studies reported fetomaternal transfusion outcomes and there were no data relating to maternal pain or discomfort during the third stage of labour.

Authors' conclusions: There was a small reduction in the length of the third stage of labour and also in the amount of blood loss when cord drainage was applied compared with no cord drainage. The clinical importance of such observed statistically significant reductions, is open to debate. There is no clear difference in the need for manual removal of placenta, blood transfusion or the risk of postpartum haemorrhage. Due to small trials with medium risk of bias, the results should be interpreted with caution.

Conflict of interest statement

David Hutchon: I have written a number of published articles and letters explaining that cord clamping before cessation of the placental circulation is an intervention with some evidence of harm.

Figures

1.1. Analysis

Comparison 1 Cord drainage versus no drainage (all), Outcome 1 Incidence of postpartum haemorrhage.

1.2. Analysis

Comparison 1 Cord drainage versus no drainage (all), Outcome 2 Retained placenta at 30 minutes after birth.

1.3. Analysis

Comparison 1 Cord drainage versus no drainage (all), Outcome 3 Manual removal of placenta.

1.4. Analysis

Comparison 1 Cord drainage versus no drainage (all), Outcome 4 Average blood loss (ml).

1.5. Analysis

Comparison 1 Cord drainage versus no drainage (all), Outcome 5 Use of blood transfusion.

1.6. Analysis

Comparison 1 Cord drainage versus no drainage (all), Outcome 6 Length of the third stage of labour.

2.1. Analysis

Comparison 2 Cord drainage versus no drainage: subgroups according to the mode of birth (normal vaginal birth Vs mixed with assisted vaginal birth), Outcome 1 Incidence of postpartum haemorrhage.

2.2. Analysis

Comparison 2 Cord drainage versus no drainage: subgroups according to the mode of birth (normal vaginal birth Vs mixed with assisted vaginal birth), Outcome 2 Retained placenta at 30 minutes after birth.

2.3. Analysis

Comparison 2 Cord drainage versus no drainage: subgroups according to the mode of birth (normal vaginal birth Vs mixed with assisted vaginal birth), Outcome 3 Average blood loss (ml).

2.4. Analysis

Comparison 2 Cord drainage versus no drainage: subgroups according to the mode of birth (normal vaginal birth Vs mixed with assisted vaginal birth), Outcome 4 Use of blood transfusion.

2.5. Analysis

Comparison 2 Cord drainage versus no drainage: subgroups according to the mode of birth (normal vaginal birth Vs mixed with assisted vaginal birth), Outcome 5 Length of the third stage of labour.

3.1. Analysis

Comparison 3 Cord drainage versus no drainage: subgroups according to administration of uterotonics before and after placental separation, Outcome 1 Incidence of postpartum haemorrhage.

3.2. Analysis

Comparison 3 Cord drainage versus no drainage: subgroups according to administration of uterotonics before and after placental separation, Outcome 2 Retained placenta at 30 minutes after birth.

3.3. Analysis

Comparison 3 Cord drainage versus no drainage: subgroups according to administration of uterotonics before and after placental separation, Outcome 3 Average blood loss (ml) (no uterotonics before placental separation).

3.4. Analysis

Comparison 3 Cord drainage versus no drainage: subgroups according to administration of uterotonics before and after placental separation, Outcome 4 Use of blood transfusion.

3.5. Analysis

Comparison 3 Cord drainage versus no drainage: subgroups according to administration of uterotonics before and after placental separation, Outcome 5 Length of the third stage of labour.

4.1. Analysis

Comparison 4 Length of third stage of labour (sensitivity analysis: excluding Sharma), Outcome 1 Length of the third stage of labour.