Fundal pressure versus controlled cord traction as part of the active management of the third stage of labour

Guiomar E Peña-Martí, Gabriella Comunián-Carrasco

There are two basic interventions to help to deliver the placenta as part of the active management of the third stage of labour: (1) fundal pressure, and (2) controlled traction on the umbilical cord. Both of these methods may, in addition, have adverse outcomes. Fundal pressure may interrupt the process of placental detachment and cause pain, haemorrhage or uterine inversion, and controlled cord traction, if undertaken before placental separation or without prior administration of a uterotonic drug, may have similar adverse effects. The obstetric clinical practice on this issue is not standardised. To determine the efficacy of fundal pressure versus controlled cord traction as part of the active management of the third stage of labour. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2007), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 2), MEDLINE (January 1966 to April 2006), EMBASE (January 1988 to April 2006) and LILACS (1982 to April 2006). We searched for published and unpublished randomised and quasi-randomised controlled trials. Two review authors independently identified potential studies from the literature search and assessed them for methodological quality and appropriateness of inclusion. The search strategies yielded five studies for consideration of inclusion. However, none of these studies fulfilled the requirements for inclusion in this review. We identified no randomised controlled trials comparing the efficacy of fundal pressure versus controlled cord traction as part of the active management of the third stage of labour. Hence controlled cord traction, after awaiting signs of placental separation, should remain the third component of the active management of third stage of labour, and follow the routine administration of a uterotonic drug and cord clamping.