title: 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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (February 2010).
  
  
  METHODS
  Randomised controlled trials comparing placental cord draining with no placental cord drainage as part of the management of the third stage of labour.
  
  
  METHODS
  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.
  
  
  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.
  
  
  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.
authors: Faculty of Health and Wellbeing, Sheffield Hallam University, 32 Collegiate Crescent, Sheffield, UK, S10 2BP.
authors: Hora
authors: H
authors: Soltani
authors: Thomas A
authors: TA
authors: Poulose
authors: David R
authors: DR
authors: Hutchon
mesh_terms: D003250:Constriction; D036861:Delivery, Obstetric / Q000379:methods*; D004322:Drainage / Q000379:methods*; D005260:Female; D005312:Fetal Blood; D006801:Humans; D007749:Labor Stage, Third / Q000502:physiology*; D010920:Placenta / Q000601:surgery; D018457:Placenta, Retained / Q000517:prevention & control; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D014470:Umbilical Cord / Q000601:surgery