title: Effect of routine controlled cord traction as part of the active management of the third stage of labour on postpartum haemorrhage: multicentre randomised controlled trial (TRACOR).
abstract: 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.
  
  
  METHODS
  Randomised controlled trial.
  
  
  METHODS
  Five university hospital maternity units in France.
  
  
  METHODS
  Women aged 18 or more with a singleton fetus at 35 or more weeks' gestation and planned vaginal delivery.
  
  
  METHODS
  Women were randomly assigned to management of the third stage of labour by controlled cord traction or standard placenta expulsion (awaiting spontaneous placental separation before facilitating expulsion). Women in both arms received prophylactic oxytocin just after birth.
  
  
  METHODS
  Incidence of postpartum haemorrhage ≥ 500 mL as measured in a collector bag.
  
  
  RESULTS
  The incidence of postpartum haemorrhage did not differ between the controlled cord traction arm (9.8%, 196/2005) and standard placenta expulsion arm (10.3%, 206/2008): relative risk 0.95 (95% confidence interval 0.79 to 1.15). The need for manual removal of the placenta was significantly less frequent in the controlled cord traction arm (4.2%, 85/2033) compared with the standard placenta expulsion arm (6.1%, 123/2024): relative risk 0.69, 0.53 to 0.90); as was third stage of labour of more than 15 minutes (4.5%, 91/2030 and 14.3%, 289/2020, respectively): relative risk 0.31, 0.25 to 0.39. Women in the controlled cord traction arm reported a significantly lower intensity of pain and discomfort during the third stage than those in the standard placenta expulsion arm. No uterine inversion occurred in either arm.
  
  
  CONCLUSIONS
  In a high resource setting, the use of controlled cord traction for the management of placenta expulsion had no significant effect on the incidence of postpartum haemorrhage and other markers of postpartum blood loss. Evidence to recommend routine controlled cord traction for the management of placenta expulsion to prevent postpartum haemorrhage is therefore lacking.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01044082.
authors.affiliation: INSERM U953, Epidemiologic Research in Perinatal, Women's, and Children's Health, Pierre et Marie Curie University, Paris, France. catherine.deneux-tharaux@inserm.fr
authors.forename: Catherine
authors.initials: C
authors.lastname: Deneux-Tharaux
authors.forename: Loic
authors.initials: L
authors.lastname: Sentilhes
authors.forename: Françoise
authors.initials: F
authors.lastname: Maillard
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Closset
authors.forename: Delphine
authors.initials: D
authors.lastname: Vardon
authors.forename: Jacques
authors.initials: J
authors.lastname: Lepercq
authors.forename: François
authors.initials: F
authors.lastname: Goffinet
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005602:France; D006801:Humans; D007749:Labor Stage, Third; D007743:Labor, Obstetric; D010920:Placenta; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D016896:Treatment Outcome; D014470:Umbilical Cord; D055815:Young Adult
references.citation: BJOG. 2007 Jul;114(7):845-54
references.pmid: 17567419
references.citation: Gynecol Obstet Fertil. 2005 Apr;33(4):268-74
references.pmid: 15894217
references.citation: BMJ. 2010 Feb 01;340:c293
references.pmid: 20123835
references.citation: Med J Aust. 1971 Apr 24;1(17):899-903
references.pmid: 4930658
references.citation: Int J Gynaecol Obstet. 2006 Sep;94(3):243-53
references.pmid: 16842791
references.citation: BMJ. 2011 Nov 15;343:d7157
references.pmid: 22089242
references.citation: Int J Gynaecol Obstet. 2006 Nov;94 Suppl 2:S126-S127
references.pmid: 29644682
references.citation: Best Pract Res Clin Obstet Gynaecol. 2008 Dec;22(6):1103-17
references.pmid: 18793876
references.citation: Lancet. 1998 Mar 7;351(9104):693-9
references.pmid: 9504513
references.citation: J Obstet Gynaecol. 2011;31(1):37-42
references.pmid: 21280991
references.citation: Acta Obstet Gynecol Scand. 2011 May;90(5):421-8
references.pmid: 21332452
references.citation: Cochrane Database Syst Rev. 2006 Apr 19;(2):CD004904
references.pmid: 16625615
references.citation: Am J Obstet Gynecol. 2008 Aug;199(2):133.e1-8
references.pmid: 18279820
references.citation: J Obstet Gynaecol Can. 2009 Oct;31(10):980-993
references.pmid: 19941729
references.citation: Am J Obstet Gynecol. 1997 Oct;177(4):770-4
references.pmid: 9369817
references.citation: Lancet. 2012 May 5;379(9827):1721-7
references.pmid: 22398174
references.citation: BMJ. 1988 Nov 19;297(6659):1295-300
references.pmid: 3144366
references.citation: BJOG. 2009 Jan;116(1):119-24
references.pmid: 19087083
references.citation: BJOG. 2005 Jan;112(1):89-96
references.pmid: 15663404
references.citation: JAMA. 2007 Mar 21;297(11):1241-52
references.pmid: 17374818
references.citation: BJOG. 2008 Jun;115(7):842-50
references.pmid: 18485162
references.citation: Clin Obstet Gynecol. 2010 Mar;53(1):147-56
references.pmid: 20142652
references.citation: Cochrane Database Syst Rev. 2011 Nov 09;(11):CD007412
references.pmid: 22071837
references.citation: BJOG. 2010 Sep;117(10):1278-87
references.pmid: 20573150
references.citation: BJOG. 2004 May;111(5):481-4
references.pmid: 15104614
references.citation: Br Med J. 1963 Dec 28;2(5373):1620-3
references.pmid: 14066183
references.citation: Midwifery. 1990 Mar;6(1):3-17
references.pmid: 2182978
references.citation: Lancet. 2006 Apr 1;367(9516):1066-1074
references.pmid: 16581405
references.citation: Cochrane Database Syst Rev. 2013 Oct 30;(10):CD001808
references.pmid: 24173606
references.citation: Bull World Health Organ. 2007 Apr;85(4):322-3
references.pmid: 17546315