Discussion
Giacalone 1
reported a randomized study comparing 239
women who had placental cord drainage with 238 women
with expectant delivery of the placenta. The median value of
duration of third stage of labour was 8 minutes in cord
drainage group and 15 minutes in the control group.
Gulati et al 2
studied 200 pregnant women to evaluate placental
blood drainage during vaginal delivery as a method of
shortening the duration of third stage and reducing the amount
of blood loss and concluded that duration of third stage of
labour in the control group was 5.72 minutes and in the
study group it was 2.94 minutes Amount of blood lost in the
third stage of labour was 247.59 ml in the control group and
193.63 ml in the study group. Incidence of postpartum
hemorrhage was 12% in the control group and 6% in the
study group. Retained placenta was observed in 4% in the
control group and in 0% in the study group.
Sharma et al 3
reported a study on 958 women having vaginal
delivery, who were randomized to the drainage method (478
women) or controlled cord traction method (480 women)
for placental delivery. The mean duration of third stage of
labor was 3.24 minutes and 3.2 minutes in the placental
drainage group in contrast to 8.57 min and 6.2 min in
controlled cord traction method in primigravida and
multigravida respectively.
The Cochrane database of systemic reviews 4
studied the
effect of placental cord drainage on the third stage of labor.
They selected the randomized trials involving placental cord
drainage as a variable within the package of intervention as
part of the management of the third stage of labor and
concluded that cord drainage results in statistically significant
reduction in the length of the third stage of labor.
In our study. the mean duration of third stage was 5.02±1.71
minutes in the cord drainage group compared to 7.42±2.56
minutes in the control group. The average blood loss in third
stage of labor was 175.05±118.15 mL in the study group
compared to 252.05±145.48 mL in the control group. The
incidence of postpartum hemorrhage was 3% in the study
group and 10% in the control group. There were no cases
of retained placenta.
Great efforts were taken to measure the blood loss
carefully, but the measurement remains open to
inaccuracies due to inclusion of some amniotic fluid and
omission of some blood that can spatter on drapes and
gowns. This can especially affect the measurement of
lower amounts of blood loss. However, the likely
measurement error should be random and will therefore
reduce the power, but not bias the results 5
.
Conclusion
Placental blood drainage is simple, safe and noninvasive
method of great use in day to day obstetric practice not
requiring any extra effort, cost or equipment. This is
relevant in rural areas also.