Placental cord drainage may be simpler, more effective than standard practice

Recent research suggests placental cord drainage should be used for better management of the third stage of labor following vaginal delivery, according to findings in BMC Pregnancy and Childbirth.¹

While the current practice during the third stage of labor is to clamp and cut the umbilical cord, then wait for signs of placental separation, the research suggests placental cord drainage is a simpler and more effective method.

In a parallel randomized trial, investigators compared postpartum outcomes of placental drainage on the duration of the third stage of labor after vaginal delivery in 340 low-risk pregnant women.

They randomized 175 women to the drainage group (n=200) and 165 women to the control group (n=200). The mean age of women in the drainage group was 27.45 (SD = 4.57) years, and it was 28.29 (SD = 4.90) for the control group (P = 0.103).

When comparing placental expulsion times between the drainage and control groups, researchers found significant differences (07:09.63 ± 01:01.756 vs 10:43.37 ± 03:20.512 minutes), indicating favorable outcomes after cord drainage. Placental cord drainage also produced significantly lower rates of postpartum hemorrhage, retained placenta, and incidence of manual placental removal.

For all women, active management was performed for placental expulsion. After delivery, 20 units of oxytocin were administered, and mothers went to the postpartum unit. Next, umbilical cords were cut and clamped—the control group received no further interventions.

After cord cutting in the drainage group, the clamp was opened, and blood was drained completely. Signs of placental separation included a sudden gush of blood into the vagina, a firmer fundus, lengthening of the umbilical cord as placenta descended into the vagina, and an elevated uterus into the abdomen. Placental delivery was then performed via the Brandt-Andrews maneuver.

Compared to the routine hospital procedure, investigators concluded that placental drainage resulted in a decreased length of the third stage of labor, probability of complications, manual placental removal, and postpartum hemorrhage.

Reference

Karimi N, Molaee G, Tarkesh Esfahani N, Montazeri A. Placental cord drainage and its outcomes at third stage of labor: a randomized controlled trial. BMC Pregnancy and Childbirth. 2022;22(1). doi:10.1186/s12884-022-04877-8