Abstract

ROLE OF CONTROLLED CORD TRACTION IN ACTIVE MANAGEMENT OF THIRD STAGE OF LABOUR: A PROSPECTIVE RANDOMISED CONTROLLED STUDY

Priyanka Dua*, Sheeba Marwah, Achla Batra and H. P. Anand

ABSTRACT

PPH remains one of the major causes of maternal mortality, especially in developing nations. Active management of third stage of labour (AMTSL) expedites the critical phase and includes interventions to reduce the incidence of PPH. Controlled cord traction, a component of AMTSL, needs skillful healthcare worker and has its own complications. Moreover its advantageous role is not clearly proved. This prospective randomized controlled trial was conducted in a busy tertiary care setup which included 150 patients. They were randomized into two groups on the basis of controlled cord traction. Control group received the full (AMTSL) package while the study group received the simplified package (without controlled cord traction). Results: There was no significant difference in the demographic profile among the two groups. Mean blood loss in study group and control group were 420.280ml and 424.453ml respectively, this difference was not significant (p =0.738). There was no statistically significant difference in the incidence of retained placenta (p=1.00) or PPH (>500ML) (p=1.00) between the two groups. No case of uterine inversion was seen in either of the two groups. Blood transfusion was required in three patients in the control group and in five patients in the study group (p=0.719). Secondary PPH occurred in 1 case of control group and 3 cases in study group (p=0.245). Conclusion: Use of uterotonics alone in management of third stage of labour is equally effective in reducing 3rdstage blood loss and preventing PPH as compared to full active management of third stage of labour. The inclusion of CCT in AMTSL does not seem to have additional benefit as far as reducing blood loss is concerned, rather a poorly performed CCT can cause potentially lethal complications.

Keywords: Controlled Cord Traction, Third Stage of Labour, Active Management.