H Soltani1, F Dickinson, I Symonds. 1. Derby Hospitals NHS Foundation Trust, Maternity Department, Uttoxeter Road, Derby, Derbyshire, UK DE22 3NE. hora.soltani@nhs.net
Abstract
BACKGROUND: Cord drainage in the third stage of labour involves unclamping the previously clamped and separated umbilical cord and allowing the blood from the placenta to drain freely into an appropriate receptacle. Currently there are no systematic reviews of the effects of placental cord drainage on the management of the third stage of labour. OBJECTIVES: The objective of this review was to assess the specific effects of placental cord drainage on the third stage of labour, with or without the prophylactic use of oxytocics. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group Trials register (July 2005), CINAHL (1982 to December 2004) and the National Research Register (December 2004). SELECTION CRITERIA: Randomised trials involving placental cord drainage as a variable within the package of interventions as part of the management of the third stage of labour. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the quality of trials and extracted data. MAIN RESULTS: Two studies met our inclusion criteria in terms of quality and relevance. Cord drainage could impact the third stage of labour as the results show a statistically significant reduction in the length of third stage of labour (one trial, n = 147, weighted mean difference (minutes) -5.46, 95% confidence interval (CI) -8.02 to -2.90). In the incidence of retained placenta at 30 minutes after birth (one trial, n = 477, relative risk 0.28, 95% CI 0.10 to 0.73) a significant difference was found, but this should be interpreted with caution due to potential intervention bias. AUTHORS' CONCLUSIONS: It is difficult to draw conclusions from such a small number of studies, especially where the review outcomes were presented in a variety of formats. However, there does appear to be some potential benefit from the use of placental cord drainage in terms of reducing the length of the third stage of labour. More research is required to investigate the impact of cord drainage on the management of the third stage of labour.
BACKGROUND: Cord drainage in the third stage of labour involves unclamping the previously clamped and separated umbilical cord and allowing the blood from the placenta to drain freely into an appropriate receptacle. Currently there are no systematic reviews of the effects of placental cord drainage on the management of the third stage of labour. OBJECTIVES: The objective of this review was to assess the specific effects of placental cord drainage on the third stage of labour, with or without the prophylactic use of oxytocics. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group Trials register (July 2005), CINAHL (1982 to December 2004) and the National Research Register (December 2004). SELECTION CRITERIA: Randomised trials involving placental cord drainage as a variable within the package of interventions as part of the management of the third stage of labour. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the quality of trials and extracted data. MAIN RESULTS: Two studies met our inclusion criteria in terms of quality and relevance. Cord drainage could impact the third stage of labour as the results show a statistically significant reduction in the length of third stage of labour (one trial, n = 147, weighted mean difference (minutes) -5.46, 95% confidence interval (CI) -8.02 to -2.90). In the incidence of retained placenta at 30 minutes after birth (one trial, n = 477, relative risk 0.28, 95% CI 0.10 to 0.73) a significant difference was found, but this should be interpreted with caution due to potential intervention bias. AUTHORS' CONCLUSIONS: It is difficult to draw conclusions from such a small number of studies, especially where the review outcomes were presented in a variety of formats. However, there does appear to be some potential benefit from the use of placental cord drainage in terms of reducing the length of the third stage of labour. More research is required to investigate the impact of cord drainage on the management of the third stage of labour.
Authors: C Winter; A Macfarlane; C Deneux-Tharaux; W-H Zhang; S Alexander; P Brocklehurst; M-H Bouvier-Colle; W Prendiville; V Cararach; J van Roosmalen; I Berbik; M Klein; D Ayres-de-Campos; R Erkkola; L M Chiechi; J Langhoff-Roos; B Stray-Pedersen; C Troeger Journal: BJOG Date: 2007-07 Impact factor: 6.531