Placental cord drainage and the effect on the duration of third stage labour, a randomized controlled trial. Routine oxytocin in the third stage of labour: a placebo controlled randomised trial.
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. To compare intravenous oxytocin administration (Partocon 10 IU) with saline solution in the management of postpartum haemorrhage in the third stage of labour.
                A double-blind, randomised controlled trial involving 1000 parturients with singleton fetuses in cephalic presentation and undergoing vaginal delivery, randomly allocated to treatment with oxytocin (n = 513) or 0.9% saline solution (n = 487).
                Labour ward at a central county hospital.
                Mean blood loss (total, and before and after placenta delivery); frequencies of blood loss > 800 mL, need of additional oxytocic treatment, postpartum haemoglobin < 10 g/dL; and duration of postpartum hospitalisation.
                As compared with saline solution, oxytocin administration was associated with significant reduction in mean total blood loss (407 versus 527 mL), and in frequencies of postpartum haemorrhage > 800 mL (8.8% versus 5.2%), additional treatment with metylergometrine (7.8% versus 13.8%), and postpartum Hb < 10 g/dL (9.7% versus 15.2%), and a nonsignificant increase in the frequency of manual placenta removal (3.5% versus 2.3%). There was no group difference in the mean duration of postpartum hospitalisation (4.6 versus 4.5 days, respectively).
                Administration of intravenous oxytocin in the third stage of labour is associated with an approximately 22% reduction in mean blood loss, and approximately 40% reductions in frequencies of postpartum haemorrhage (> 500 mL or > 800 mL) and of postpartum haemoglobin < 10 g/dL. Identification of risk groups for oxytocin treatment does not seem worthwhile. Oxytocin is a cheap atoxic drug and should be given routinely after vaginal delivery.
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.