ABSTRACT
Background: Labour is a physiological process, but it is often associated with morbidity and mortality, with the most common cause being blood loss. Primary postpartum hemorrhage is commonly defined as a blood loss of 500 ml or more within 24 hours after normal vaginal birth. A prolonged third stage of labour (more than 20 min) is associated with postpartum hemorrhage. The present study was undertaken with the objective of assessing efficacy of placental cord drainage (PCD) during active management of third stage of labour.Methods: This is a randomized control trial in which full term primi gravida who were expected to have normal vaginal delivery, admitted in labour room of a tertiary care centre were evaluated for inclusion in the study. Total 126 participants were enrolled after having normal vaginal delivery. In study group (n = 63), placental cord drainage was used for management of third stage of labour while in control group (n = 63), third stage was managed without PCD.Results: The mean difference in duration of third stage of labour in study and control group was 1.79 minute and the mean difference in blood loss during third stage of labour in both groups was 57.86 ml which was statistically significant.Conclusions: The results of this study show small positive effects from cord drainage in reducing the length of the third stage of labour and in reducing the amount of blood loss when compared with those without cord drainage. The observed changes may be of clinical significance in reducing third stage related complications.
ABSTRACT
Background: Globally and especially in the under developing nations Postpartum Hemorrhage (PPH) is the most common cause of maternal mortality. All women who deliver are at risk of complications of third stage of labor. Multiple researches have been done to compare active vs expectant management of third stage of labor. Placental Cord Drainage (PCD), one of the active method for control of third stage of labor, incudes opening of clamp from mother’s side of umbilical cord thereby allowing the blood from placenta to flow freely immediately after clamping and cutting of the umbilical cord. Aim: Thus, the following study was conducted to assess the effect of PCD via umbilical cord in decreasing the time period of third stage of labor and incidence of PPH. Materials and Methods: This hospital based comparative study was conducted in the department of Obstetrics and Gynecology, National Institute of Medical Sciences & Research, Jaipur. A total of 300 consecutive patients with term pregnancy (>37 weeks) fulfilling the inclusion criteria were taken after informed consent. These were divided into two groups of 150 cases each, study group (PCD group) and control group. The various parameters like blood loss, need for transfusion, duration of third stage of labor, manual removal of placenta, hospital stay, secondary PPH (after 24 hours and before 6 weeks) were noted for every female. Statistical analysis was done using t-test for quantitative data, nonparametric data was analyzed by Mann Whitney test and categorical data was analyzed using chisquare test. The significance threshold of p-value was set at <0.05. All analysis was carried out by using SPSS software version 21. Results: Average blood loss was significantly less in subjects of drainage group as compared to control group (273.8 ml vs 391.2 ml; p<0.05). Also, average duration of third stage of labor was significantly less in drainage group (4.1 vs 7.7 mins; p<0.05). No difference was observed between two groups based on placenta weight (p-0.121). Conclusion: In the present study, PCD had a beneficial effect on the duration of third stage of labor and on postpartum blood loss. Thus, use of PCD is recommended in active management of labor by trained professionals