Controlled cord traction to deliver the placenta should remain as part of the active management of third stage of labour.
The third stage of labour is the period from the birth of the baby until delivery of the placenta. There are two basic interventions to help to deliver the placenta as part of the active management of the third stage of labour: fundal pressure or controlled cord traction. Fundal pressure (Crede manoeuvre) involves placing one hand on the top of the uterus (uterine fundus) and squeezing it between the thumb and other fingers to help placental separation and delivery. Controlled cord traction involves traction on the umbilical cord while maintaining counter-pressure upwards by placing a hand on the lower abdomen. Also, controlled cord traction should only follow signs of placental separation. Both these interventions, if not performed correctly, may have adverse outcomes including pain, haemorrhage and inversion of the uterus. Two other methods of placenta delivery are not advised because they may be dangerous: these are uterine manipulation and cord traction. The review found no randomised controlled trials to assess the use of fundal pressure as part of the active management of the third stage of labour. Therefore, controlled cord traction should continue as the method of placental delivery in the active management of third stage of labour.