The third stage of labour begins immediately after the birth of the baby and ends with the expulsion of the placenta and fetal membranes. It is preceded by contraction and retraction of the uterus to reduce uterine size and expel the placenta with minimal haemorrhage. The third stage of labour can be managed actively or by expectant management, where the umbilical cord remains attached to the baby until after delivery of the placenta; blood within the placental compartment drains into the baby. Placental cord drainage involves clamping and cutting of the umbilical cord after the birth of a baby and then, immediately unclamping the maternal side of the cord so the blood can drain freely into a container. This may or may not, be used together with other interventions such as routine administration of an oxytocic drug (to contract the womb), controlled cord traction (applying traction to the cord with counter-pressure on the womb to deliver the placenta) or maternal effort.
This review included three studies involving 1257 birthing women. The findings showed that placental cord drainage in the management of third stage of labour reduced the length of third stage of labour by a mean of about three minutes and reduced blood loss by average of 77 ml. There was no clear difference in the manual removal of placenta or the risk of postpartum haemorrhage or incidence of blood transfusion. The trials did not report on maternal pain or discomfort during the third stage of labour. Some of the outcomes were not reported in the same way in all trials, limiting the amount of information available for analysis. Other desired outcomes were either not reported or were not reported in an appropriate way for statistical analysis (e.g. placenta not delivered within 30 minutes after birth, maternal haemoglobin changes). Further investigation of the effect of placental cord drainage on maternal outcomes would be useful although it is not a priority area for maternity research.