As a method of placenta removal following cesarean delivery, cord traction is associated with fewer complications and a shorter hospital stay than is manual removal, according to a systematic review by Cochrane researchers.
According to the report, which appears in the July 16th online issue of The Cochrane Library, use of cord traction reduces blood loss and is less likely to cause endometritis.
"Although cord traction may take a little bit longer, there are clear health benefits of this method over manual removal of the placenta," lead author Dr. Rose Anorlu, from the University of Lagos in Nigeria, said in a statement.
Searching the Cochrane Pregnancy and Childbirth Group's Trials Register, Dr. Anorlu and colleagues identified 15 randomized controlled trials, involving 4694 women, that compared methods of placental removal after c-section.
Relative to cord traction, manual removal increased the odds of endometritis by 64% and was associated with greater blood loss and with a bigger drop in hematocrit after delivery. Moreover, the average hospital stay was 0.39 days longer, on average, with manual removal rather than cord traction.
By contrast, no difference between the methods was seen in blood transfusion, feto-maternal hemorrhage, and puerperal fever, although the authors point out that patient numbers for these endpoints were small.
"A possible longer interval between birth of the baby and delivery of the placenta is the only disadvantage (with cord traction), but this did not significantly increase the overall duration of surgery," the investigators note.
Cochrane Database Syst Rev 2008;3.
Reviewed by Ramaz Mitaishvili, MD
