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Simplified Delivery Has Little Effect on Bleeding Risk

Omitting controlled cord traction has little effect when oxytocin is administered

TUESDAY, March 6 (HealthDay News) -- Omitting controlled cord traction, a procedure to extract the placenta that requires a skilled birth attendant, after delivery has little effect on the risk of excessive postpartum bleeding when oxytocin is administered immediately after birth, according to a study published online March 6 in The Lancet.

A. Metin Gulmezoglu, M.D., from the World Health Organization in Geneva, and colleagues randomly assigned over 24,000 pregnant women from Argentina, Egypt, India, Kenya, the Philippines, South Africa, Thailand, and Uganda delivering singleton babies vaginally to receive a simplified package at delivery (placental delivery with gravity and maternal effort) or the full package (controlled cord traction immediately after uterine contraction and cord clamping). All women received oxytocin immediately after birth.

Based on blood loss of 1,000 mL or more, the researchers found that postpartum hemorrhage occurred in 2.1 percent of women receiving the simplified package and in 1.9 percent of women receiving the full package (risk ratio, 1.09). For the simplified package, the average blood loss was 282 mL and third-stage labor lasted an average of 12.6 minutes, while the corresponding numbers were 271 mL and 6.1 minutes for the full package.

"Although the hypothesis of non-inferiority was not met, omission of controlled cord traction has very little effect on the risk of severe hemorrhage," Gulmezoglu and colleagues conclude. "Our findings strengthen the need to focus on strategies to scale up the use of oxytocin in peripheral health care settings as the primary component of active management of the third stage of labor."

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