Routine management of the third stage of labour and controlled cord traction
This is the period from the delivery of the fetus to the delivery of the placenta, and normally should not last more than 30 minutes. Routine administration of prophylactic oxytocic agents (Syntocinon or ergometrine) is the most effective way to prevent postpartum haemorrhage, and should be given immediately after the birth of the baby (19).
Controlled cord traction to deliver the placenta only has a minor contribution to the reduction of postpartum blood loss.Indication and procedure of controlled cord traction
If the placenta is not delivered spontaneously, controlled cord traction can be performed to shorten the third stage of labour.
One hand of the operator is placed on the abdomen to feel for uterine contractions. When a contraction is felt, the other hand exerts steady traction to the cord such that the placenta could separate from the uterus and is delivered. At the same time, the ‘abdominal’ hand must exert a counter (upward) pressure at the lower part of the uterus. It is crucial that the traction is applied during a contraction to prevent uterine inversion. The placenta should be examined to be complete after it is delivered. If the placenta fails to be delivered, or part of the placenta is left in utero, manual removal of the placenta has to be performed under anaesthesia.