A randomised evaluation of two techniques of management of the third stageof labour in women at low risk of postpartum haemorrhage

Objective To determine whether early placental drainage plus cord traction reduces die incidences of manual removal and blood loss, and to determine t he risk factors associated with blood loss after delivery. Design Prospective randomised study. Setting University teaching hospital, Montpellier, France. Methods A randomised study compared 239 women who had placental cord draina ge plus cord traction with 238 women with expectant delivery. The need for manual removal of the placenta and the drop in haemoglobin after delivery w ere assessed. The duration of the third stage of labour and the time betwee n birth and the beginning of perineal suturing were measured. Statistical a nalysis used the paired t test for continuous variables, the Kruskal-Wallis test for nonparametric data and chi(2) test for categoric variables. Stepw ise logistic regression analyses were performed with a drop in haemoglobin as the outcome variable. Results No significant difference was found in the two groups with regard t o the incidence of manual removal of retained complete or incomplete placen ta or postpartum haemorrhage. The median values of the duration of the thir d stage of labour, birth-to-perineal suture time and drop in haemoglobin we re significantly lower in the cord drainage group than in the control group . After controlling for confounding variables, parity proved to be the only significant predictor of drop in haemoglobin. Conclusion Cord drainage decreases the duration of the third stage of labou r and reduces blood loss but not the incidence of manual removal of the pla centa.