Placental Blood Drainage as a Part of Active Management of Third Stage of Labour After Spontaneous Vaginal Delivery

Abstract

Aim: The third stage of labour commences after the delivery of the foetus and ends with the delivery of the placenta and its membranes. Postpartum haemorrhage is the most common cause of maternal mortality and accounts for about 25 % of maternal deaths in India.

Objectives: The present study was designed to evaluate the effectiveness of placental blood drainage after spontaneous vaginal delivery as part of active management of third stage of labour in decreasing the duration, blood loss, and complications of the third stage, against no drainage of placental blood.

Methodology: Two hundred pregnant patients with 37 or more weeks of gestation, with single live foetus in cephalic presentation, who underwent a spontaneous vaginal delivery, were included in the study. The patients were prospectively randomized equally into two groups (100 each in the study and control groups). Placental blood was drained in all the patients in the study group, whereas in the control group the cord blood was not drained. Blood lost in the third stage of labour was measured by collecting in a disposable conical measuring bag, and blood from the episiotomy was mopped, and the mops were discarded separately.

Results: The baseline statistics in both the group were comparable. The duration of third stage of labour was 210.5 s in the study group and 302.5 s in the control group. The 'p' value was statistically significant (p ≤ 0.0001). The mean blood loss in study group was 227.5 ml and was 313.3 ml in the control group (p ≤ 0.0001). The incidence of postpartum haemorrhage was 1 % in study group and 9 % in control group. The mean drop in Hb % level was 0.6 gm/dl in study group and 1.1 gm/dl in control group. These above differences were both statistically significant.

Conclusion: Placental blood drainage as part of active management of third stage of labour was effective in reducing the duration, the blood loss, and also the incidence of PPH. Placental blood drainage is a simple, safe, and non-invasive method of managing the third stage of labour, which can be practiced in both tertiary care centres as well as rural setup in addition to the routine uterotonics.

Keywords: AMTSL; Maternal mortality; Placental blood drainage.

Conflict of interest statement

There is no conflict of interest involved between the authors of the study. Informed Consent Written informed consent has been obtained from all the patients before they were enrolled into the study.