Cervical traction: a simple step ahead in the prevention of postpartum hemorrhage

Harshita Naidu, Sujatha B. S., Muralidhar V. Pai


Background: Postpartum hemorrhage is the most common preventable cause of maternal mortality in developing countries. The present study aimed to examine the impact of cervical traction technique in reducing the amount of postpartum blood loss and rate of PPH.

Methods: This was a case-control, pilot study conducted in a tertiary hospital between June 2017 to June 2018. A total of 200 singletons, low-risk pregnant females, undergoing normal vaginal delivery, were enrolled in this study. Subjects showing a high risk for PPH were excluded. Patients were randomized as case group (n=100) and control group (n=100). The case group received sustained traction for 90 seconds to anterior and posterior lip of the cervix with active management of the third stage of labor, whereas the control group received routine active management of the third stage of labor. All subjects were followed up for 6 hours post-delivery. The amount of blood loss, hematocrit and hemoglobin post-delivery were compared between both groups.

Results: The mean blood loss (ml), decrease in hemoglobin (g/L) and decrease in hematocrit post-delivery in cases were significantly low compared to controls (207±37.6 versus 340±49, P<0.01), (0.78±0.2 versus 1.4±0.3, P=0.03) and (1.7±0.2 versus 3.5±0.2, P<0.01). PPH occurred in 7 of 200 (3.5%) patients. The difference in the number of PPH was not significant (5/100; 5% versus 2/100; 2% P=0.2). There were no complications reported due to cervical traction.

Conclusions: Cervical traction is a simple and safe maneuver to reduce the amount of postpartum blood loss. Larger RCT is recommended to investigate the reduction in PPH rate.


Cervical traction, Blood loss, Maneuver, Maternal mortality, Postpartum hemorrhage, Vaginal delivery

Full Text:



Trends in Maternal Mortality: 1990 to 2010. WHO, UNICEF, UNFPA, and The World Bank estimates. Geneva, WHO, 2012. Available at: Accessed on 1st September 2012.

Haeri S, Dildy III GA. Maternal Mortality from Hemorrhage. Seminars Perinatol. 2012;36(1):48-55.

Knight M. Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group. BMC Pregnancy Childbirth. 2009;9(1):55.

Postpartum hemorrhage, 2019. Available at:

Priority medicines for Europe and the World "A Public Health Approach to Innovation", 2013. Available at: areas/priority_medicines/BP6_16PPH.pdf.

Hamdy A. A new maneuver for prevention of postpartum haemorrhage. J Obstet Gynecol India. 2014;65(4):241-5.

Preethima T, Jayashree V, Latha K. A study of sustained cervical traction in the prevention of post partum hemorrhage. Int J Modern Res Rev. 2019;4(11):1368-71.