Placental cord drainage and the effect on the duration of third stage labour, a randomized controlled trial. The effect of placental removal method and site of uterine repair on postcesarean endometritis and operative blood loss.
To assess the effect of placental cord drainage on the duration of third stage labor, and to clarify the safety of this method regarding to postpartum hemorrhage, retained placenta, incidence of manual removal of placenta, and the need for blood transfusion.
                Randomized controlled trial.
                King Chulalongkorn Memorial Hospital.
                One hundred women in the third stage of labour after vaginal delivery were randomized. In the study group, placental cord drainage was performed. In both groups, the placenta was delivered by Brandt Andrew method. One case of placenta succenturiata was subsequently excluded. The duration of third stage was compared as the primary outcome. The incidence of postpartum hemorrhage, retained placenta, manual removal of placenta, and the need for blood transfusion were compared.
                In 99 cases with normal placentas, 49 cases were assigned to the study group, 50 cases were assigned to the control group. The third stage of labor was significantly shorter after placental cord drainage (5.1 +/- 2.4 minutes vs. 7.0 +/- 6.1 minutes). There was no postpartum hemorrhage, uterine atony, hypovolemic shock, or the need for blood transfusion in neither groups.
                Placental cord drainage shortens the duration of third stage labour. This method appears to be safe and does not increase postpartum complication. Our purpose was to determine whether blood loss during cesarean section and postoperative endometritis rate were associated with the method of placental removal and site of uterine repair.
                This prospective randomized study involved 840 women who underwent cesarean section. The patients were grouped into four: (1) manual placental delivery + exteriorized uterine repair; (2) spontaneous placental delivery + exteriorized uterine repair; (3) manual placental delivery + in situ uterine repair; (4) spontaneous placental delivery + in situ uterine repair. Patients were excluded if they had received intrapartum antibiotics, had chorioamnionitis, required an emergency cesarean hysterectomy, had rupture of membranes for more than 12 hr, had bleeding diathesis, and had abnormal placentation or prior postpartum hemorrhage. The main outcome measures were postoperative hemoglobin and hematocrit values, and postcesarean endometritis.
                There were no statistically significant differences in mean maternal age, parity, gestational age, presence and duration of membrane rupture and number of vaginal examinations between the four groups. The decrease in postoperative hemoglobin (P < 0.05) and hematocrit (P < 0.001) was significantly greater in the manual removal groups (groups 1 and 3) than in the spontaneous expulsion groups (groups 2 and 4) at 48 hr postoperatively. The incidence of postoperative endometritis was significantly higher in manual removal groups (15.2%) (groups 1 and 3) than in spontaneous groups (5.7%) (groups 2 and 4) (P < 0.05).
                Manual removal of the placenta at cesarean delivery results in more operative blood loss and a higher incidence of postcesarean endometritis.
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.