• Catherine Deneux-Tharaux, Loic Sentilhes, Françoise Maillard, Emmanuel Closset, Delphine Vardon, Jacques Lepercq, and François Goffinet.
• INSERM U953, Epidemiologic Research in Perinatal, Women's, and Children's Health, Pierre et Marie Curie University, Paris, France. catherine.deneux-tharaux@inserm.fr
• BMJ. 2013 Jan 1;346:f1541.

ObjectiveTo assess the impact of controlled cord traction on the incidence of postpartum haemorrhage and other characteristics of the third stage of labour in a high resource setting.DesignRandomised controlled trial.SettingFive university hospital maternity units in France.ParticipantsWomen aged 18 or more with a singleton fetus at 35 or more weeks' gestation and planned vaginal delivery.InterventionsWomen were randomly assigned to management of the third stage of labour by controlled cord traction or standard placenta expulsion (awaiting spontaneous placental separation before facilitating expulsion). Women in both arms received prophylactic oxytocin just after birth.Main Outcome MeasureIncidence of postpartum haemorrhage ≥ 500 mL as measured in a collector bag.ResultsThe incidence of postpartum haemorrhage did not differ between the controlled cord traction arm (9.8%, 196/2005) and standard placenta expulsion arm (10.3%, 206/2008): relative risk 0.95 (95% confidence interval 0.79 to 1.15). The need for manual removal of the placenta was significantly less frequent in the controlled cord traction arm (4.2%, 85/2033) compared with the standard placenta expulsion arm (6.1%, 123/2024): relative risk 0.69, 0.53 to 0.90); as was third stage of labour of more than 15 minutes (4.5%, 91/2030 and 14.3%, 289/2020, respectively): relative risk 0.31, 0.25 to 0.39. Women in the controlled cord traction arm reported a significantly lower intensity of pain and discomfort during the third stage than those in the standard placenta expulsion arm. No uterine inversion occurred in either arm.ConclusionsIn a high resource setting, the use of controlled cord traction for the management of placenta expulsion had no significant effect on the incidence of postpartum haemorrhage and other markers of postpartum blood loss. Evidence to recommend routine controlled cord traction for the management of placenta expulsion to prevent postpartum haemorrhage is therefore lacking.Trial RegistrationClinicalTrials.gov NCT01044082.

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