WHO recommendation on controlled cord traction

illustration of cord traction

WHO recommendation on controlled cord traction

 

Recommendation

In settings where skilled birth attendants are available, controlled cord traction (CCT) is recommended for vaginal births if the care provider and the parturient woman regard a small reduction in blood loss and a small reduction in the duration of the third stage of labour as important.

(Recommended)

 

Publication history

First published: September 2012

Updated: No update planned 

Assessed as up-to-date: September 2012

 

Remarks

  • These recommendations have been integrated from the WHO recommendations for the prevention and treatment of postpartum haemorrhage, in which the GDG for that guideline determined them to be strong recommendations based on moderate-quality evidence. (WHO recommendation on controlled cord traction after vaginal birth for the prevention of postpartum haemorrhage in settings where skilled birth attendants are available)
  • This recommendation is based on a large RCT in which oxytocin 10 IU was used for the prevention of postpartum haemorrhage (PPH) in all participants. Based on this evidence, CCT was regarded as safe when applied by skilled birth attendants as it provides small beneficial effects on blood loss (average reduction in blood loss of 11 ml) and on the duration of the third stage of labour (average reduction of 6 minutes). The care provider should discuss the decision to implement CCT in the context of a prophylactic uterotonic drug with the woman.
  • If ergot alkaloids are used for the prevention of PPH, then CCT to minimize placenta retention is regarded as essential.  
  • There is insufficient evidence to determine the benefits or risks of CCT when used in conjunction with misoprostol.  
  • CCT is the first intervention to treat retained placenta; therefore, the teaching of CCT in medical and midwifery curricula is essential.  
  • Based on the most recent evidence, understanding about the contribution of each component of the active management of the third stage of labour package has evolved. The GDG considered that this package has a primary intervention: the use of a uterotonic. In the context of oxytocin use, CCT may add a small benefit, while uterine massage may add no benefit for the prevention of PPH. Early cord clamping is generally contraindicated.
  • The evidence supporting these recommendations can be found in the source guideline document, available at:    apps.who.int/iris/bitstream/handle/10665/112826/WHO_RHR_14.15_eng.pdf?sequence=1

         

 

Related links

WHO recommendations on intrapartum care for a positive childbirth experience

(2018) - full document and evidence tables

Managing Complications in Pregnancy and Childbirth: A guide for midwives and doctors

Pregnancy, Childbirth, Postpartum and Newborn Care: A guide for essential practice

WHO Programmes: Sexual and Reproductive health

Maternal Health

 

Citation: WHO Reproductive Health Library. WHO recommendation on controlled cord traction (February 2018). The WHO Reproductive Health Library; Geneva: World Health Organization.