Placental cord drainage during third stage of labour: a randomized control trial at a tertiary care centre

Megha Chaudhary, Maitri Shah, Nitin Makwana


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.


Active management of third stage of labour, Placental cord drainage, Postpartum hemorrhage

Full Text:



Maswime S, Buchmann E. A systematic review of maternal near miss and mortality due to postpartum hemorrhage. Int J Gynaecol Obstet. 2017;137(1):1-7.

Edhi MM, Aslam HM, Naqvi Z, Hashmi H. Post partum hemorrhage: causes and management. BMC Res Notes. BMC Research Notes. 2013;6(1):1.

Frolova AI, Stout MJ, Tuuli MG, López JD, Macones GA, Cahill AG. Duration of the third stage of labor and risk of postpartum hemorrhage. Am J Obtet Gynaecol. 2016;127(5):951-6.

Jongkolsiri P. Placental cord drainage and the effect on the duration of third stage labour, a randomized controlled trial. J Med Assoc Thai. 2009;92(4):457-60.

Leduc D, Vyta Senikas AL. Active management of the third stage of labour: prevention and treatment of postpartum hemorrhage. Clinical practice obstetrics committee. J Obstet Gynaecol Canada. 2010;108(3):258-67.

Piphat Jongkolsiri SMM. Placental cord drainage and the effect on the duration of third stage labour, a randomized controlled trial. Dep Obstet Gynecol Fac Med Chulalongkorn Univ Hosp Bangkok, Thailand. 2009;92(4):457-60.

Magann EF, Doherty DA, Briery CM, Amy Niederhauser JCM. Timing of placental delivery to prevent post‐partum haemorrhage: lessons learned from an abandoned randomised clinical trial. Aust N Z J Obs Gynaecol. 2006;46(6):549-51.

Sharma JB, Pundir P, Malhotra MAR. Evaluation of placental drainage as a method of placental delivery in vaginal deliveries. Arch Gynecol Obs. 2005;271(4):343-5.

Giacalone PL, Vignal J, Daures JP, Boulot P, Hedon B, Laffargue F. A randomised evaluation of two techniques of management of the third stage of labour in women at low risk of postpartum haemorrhage. BJOG An Int J Obstet Gynaecol. 2000;107(3):396-400.

Gulati N. Chauhan MBRM. Placental blood drainage in management of third stage of labor. J Obstet Gynaecol (Lahore). 2001;51(6):46-8.

Roy P, Ambarisha MSS, Bivas B, Anumita B. Placental blood drainage as a part of active management of third stage of labour after spontaneous vaginal delivery. J Obstet Gynecol India. Springer India. 2016;66(1):242-5.

Kaba M, Üstün YE, Gül E, Eyİ Y, Tİmur H, Ünlü BS. Placental blood drainage shortens duration of the third stage of labor in women slowly administered 20 IU oxytocin. Gynecol Obstet Reprod Med. 2017;23(1):6-10.

Soltani H, Poulose T HD. Placental cord drainage after vaginal delivery as part of the management of the third stage of labour. Cochrane Database Syst Rev. 2011;9:CD004665.

Shravage JC, Silpa P. Randomized controlled trial of placental blood drainage for the prevention of postpartum hemorrhage. J Obstet Gynecol India. 2007;57(3):213-5.

Magann EF, Evans S, Chauhan SP, Lanneau G, Fisk AD MJ. The length of the third stage of labor and the risk of postpartum hemorrhage. Obs Gynecol. 2005;105(2):290-3.