Pdf effect of routine controlled cord traction as part. Multiple interventions medical, mechanical, invasive nonsurgical. This is a pdf file of an unedited manuscript that has been accepted for publication. Pdf to assess the impact of controlled cord traction on the incidence of postpartum haemorrhage and other characteristics of the third stage of labour. Postpartum haemorrhage carboprost uncontrolled document when printed published. Cct facilitates expulsion of the placenta once it has separated from the uterine wall. Prophylactic management of postpartum haemorrhage in the third stage of labour. Who recommendation on controlled cord traction after vaginal birth for the prevention of postpartum haemorrhage in settings where skilled birth attendants are unavailable september 2012. Although amtsl reduces postpartum blood loss, about 3% to 16. Even with these efforts to prevent pph, some women will still require treatment for excessive bleeding. Active management of the third stage of labour without.
In these 3 studies, the addition of controlled cord traction to active management was associated with a very slight reduction in risk of blood loss. Postpartum haemorrhage is a direct cause of maternal death worldwide and usually occurs during the third stage of labour. Recent recommendations are to delay cord clamping until the caregiver is ready to initiate cct. Controlled traction on the cord during a contraction combined with countertraction upward on the uterus with the providers hand placed immediately above the symphysis pubis. Who recommendations for the prevention and treatment of. Postpartum haemorrhage is a direct cause of maternal death worldwide and usually occurs during. This guideline is an update of the who recommendations for the prevention of postpartum haemorrhage. Active management of the third stage of labor with and without. Postpartum haemorrhage is a leading cause of maternal morbidity and mortality worldwide. Pph is the most common form of obstetric haemorrhage and is a leading cause of morbidity and mortality. In these 3 studies, the addition of controlled cord traction. Cct has the advantage of reducing the risk of manual removal of the.
Scaling up of haemorrhage prevention programmes for nonhospital settings can safely focus on use of oxytocin. However, the reduction in the occurrence of severe postpartum hemorrhage, need for additional uterotonics and blood transfusion is not statistically significant. American journal of obstetrics and gynecology 2001. Postpartum haemorrhage is a major cause of severe morbidity and maternal death, particularly in africa and asia, where nearly a third of pregnancyrelated deaths are associated with haemorrhage. Active management of the third stage of labour with and. Who recommendations for the prevention and treatment of postpartum haemorrhage 2 abbreviations agree appraisal of guidelines research and evaluation amtsl active management of the third stage of labour cct controlled cord traction ci confidence interval great guideline development, research priorities, evidence synthesis. Controlled cord traction during the third stage of labor aafp. Routine use of uterotonic oxytocic medications earlydeferred clamping and cutting of the cord controlled cord traction cct after signs off separation of the placenta.
Based on this evidence, controlled cord traction cct was regarded as safe. Postpartum haemorrhage pph remainsa major cause of maternal mortality andmorbidity worldwide. The usual components include dministration of uterotonic a agents, controlled cord traction and uterine massage after birth of the placenta, as appropriate ref icmfigo joint statement. Pdf effect of routine controlled cord traction as part of the active. The need for manual removal of the placenta was significantly less frequent in the controlled cord traction. All but one of the enrolled women received prophylactic oxytocin, and late umbilical cord clamping was used in 77. Controlled cord traction uterine massage after delivery of placenta.
Postpartum haemorrhage is defined as blood loss of 500ml or more. Of note, umbilical cord traction has not been demonstrated to reduce the need for blood transfusion or the incidence of postpartum hemorrhage pph 1,000 ml, and it is commonly utilized by obstetricians and midwives. The current available interventions for prevention of postpartum haemorrhage, oxytocin and carbetocin, are limited by their need for refrigeration to maintain potency, as the ability to maintain a cold chain across the drug. Manual removal of the placenta was reduced with cct two trials. Controlled cord traction versus minimal intervention techniques in. A randomized controlled trial comparing oxytocin administration before and after placental delivery in the prevention of postpartum hemorrhage. Who recommendations for the prevention of postpartum haemorrhage. Controlled cord traction cord clamping timing uterine massage. As a service to our customers we are providing this early version of the manuscript. Active management of the third stage of labour amtsl consists of a group of interventions, including administration of a prophylactic uterotonic at at or after delivery of the baby, baby, cord clamping and cutting, controlled cord traction cct to deliver the placenta, and uterine massage. To evaluate the effects of controlled cord traction during the third stage of.
Controlled cord traction in active management of the third. To show a reduction of at least 30% in the incidence of postpartum haemorrhage in the controlled cord traction armthat is, an incidence of 4. A pilot randomized controlled trial of controlled cord traction to reduce postpartum blood loss. Controlled cord traction for the third stage of labour ncbi. Postpartum bleeding or postpartum hemorrhage pph is often defined as the loss of more than 500 ml or 1,000 ml of blood within the first 24 hours following childbirth. Although the hypothesis of noninferiority was not met, omission of controlled cord traction has very little effect on the risk of severe haemorrhage. Controlled cord traction for the third stage of labour. Obstetric haemorrhage, especially postpartum haemorrhage pph, was responsible for more than a quarter of the estimated 303 000 maternal deaths that occurred globally in 2015. The third stage of labour refers to the period between birth of the baby and complete expulsion of the placenta. Prevention and treatment of postpartum hemorrhage at the. Who recommendation on controlled cord traction rhl.
Postpartum haemorrhage refers to anyamount of bleedingfrom or into thegenital tract followingbirth of the baby uptothe end ofpuerperium. Active management of third stage definition includes1. Primary postpartum haemorrhage refer to online version, destroy printed copies after use page 5 of 37 abbreviations. Who recommendations for the prevention of postpartum. The benefits of controlled cord traction and uterine massage in preventing postpartum hemorrhage are less clear, but these strategies may be helpful. The incidence of postpartum haemorrhage did not differ between the controlled cord traction arm 9. As a service to our customers we are providing this early version of the. However, the reduction in the occurrence of severe postpartum hemorrhage, need for. We searched pubmed, scopus and web of science inception to 30 october 20. Controlled cord traction cct is the recommended method for the removal of the placenta. Effect of routine controlled cord traction as part of the.
The usual components include administration of uterotonic agents, controlled cord traction and. Deneuxtharaux c, sentilhes l, maillard f et al 20 effect of routine controlled cord traction as part of the active management of the third stage of labour on postpartum haemorrhage. Some have added the requirement that there also be signs or symptoms of low blood volume for the condition to exist. Postpartum hemorrhage association of ontario midwives. The importance of controlled cord traction cct was revisited because of new evidence. To evaluate the effects of controlled cord traction during the third stage of labour, either with or without conventional active management. Search methods we searched the cochrane pregnancy and childbirth groups trials register 29 january 2014, pubmed 1966 to 29 january 2014, and reference lists of retrieved studies.
A pilot randomized controlled trial of controlled cord. Postpartum haemorrhage pph is the leading cause of maternal mortality in lowincome countries and contributes to nearly a quarter of maternal deaths globally. Active management and controlled cord traction three relevant randomized controlled trials have compared active management of the third stage of labour with and without controlled cord traction. Third stage labour management clinical guideline the royal. Active management of the third stage of labor with and. Their conclusion is based on evidence from hospital settings in which all women received oxytocin prophylaxis, and thus might not apply to those with limited or no access to. This period is a risky period because uterus may not contract well after birth and heavy blood loss can endanger the life of the mother. Who recommendation on controlled cord traction after vaginal birth for the. Who recommendation on controlled cord traction after vaginal birth.
If in spite of controlled cord traction, administration of. Two management packages for the third stage of labour are commonly used, known as active. This guideline document is not intended to provide a comprehensive practical guide for the prevention and treatment of postpartum haemorrhage pph. Who recommendations for the prevention of postpartum haemorrhage 5 in contrast to active management, expectant management involves waiting for signs of separation and allowing the placenta to deliver spontaneously, or aided by gravity or nipple stimulation. If ergot alkaloids are used for the prevention of pph, then cct is. Participants women aged 18 or more with a singleton fetus at 35 or more weeks gestation and planned vaginal. Abg arterial blood gas aptt activated partial thromboplastin time cct controlled cord traction ci confidence interval cs caesarean section hb haemoglobin fbc full blood count. Though controlled cord traction was an initial component of amtsl, but, three rcts assessing amtsl with and without cord traction found no significant difference in the risk of pph 55. Who recommendation on controlled cord traction after. Effect of routine controlled cord traction as part of active management of third stage of. Post partum hemorrhage pph is a major cause of maternal mortality worldwide, accounting for approximately 100 000 deaths annually.
Physiologic management during the 3rd stage of labor abstract background. Routine use of a uterotonic drug more than halves the risk of postpartum haemorrhage 5, but the effects of timing of cord clamping 6 and controlled cord traction are unclear 7. Some degree of blood loss occurs after the birth of the baby due to separation of the placenta. If ergot alkaloids are used for the prevention of pph, then cct to minimize. Postpartum haemorrhage pph is a major cause of maternal deaths in both. Objective to assess the impact of controlled cord traction on the incidence of postpartum haemorrhage and other characteristics of the third stage of labour in a high resource setting. Postpartum haemorrhage pph is commonly defined as a blood loss of 500 ml or more within 24 hours after birth. The overall incidence of postpartum hemorrhage was significantly lower in the controlled cord traction group 5. For controlled cord traction and standard placenta expulsion, the correct values are, respectively. Prophylactic management of postpartum haemorrhage in the. Prevention and treatment of postpartum haemorrhage author.
Setting five university hospital maternity units in france. Controlled cord traction appears to reduce the risk of any postpartum hemorrhage in a general sense, as well as manual removal of the placenta and the duration of the third stage of labor. Prevention and treatment of postpartum haemorrhage a. Yuko masuzawa1, yaeko kataoka2, kana fujii2 and satomi inoue1 abstract background. The package of amtsl reduces the risk of postpartum haemorrhage, pph. Controlled cord traction appears to reduce the risk of any postpartum hemorrhage in a general sense, as well as manual removal of the placenta. E ect of routine controlled cord traction as part of the active management of the third stage of labour on postpartum haemorrhage. A common aetiology is uterine atony, which can often be related to the intrapartum management of labour. The evidencebased management of postpartum haemorrhage pdf. In 20032005, around 9 in every 100,000 women who gave birth in the uk died through subsequent postpartum haemorrhage. Clamping of the umbilical cord and placental transfusion. Room temperature stable carbetocin for the prevention of.
1536 1132 79 95 650 756 177 420 1524 232 1314 454 1110 754 47 1149 972 112 123 709 623 415 1085 1171 229 1101 195 1314 322 521 251 567 294