Soltani Hora, Poulose Thomas A, Hutchon David R
Faculty of Health and Wellbeing, Sheffield Hallam University, 32 Collegiate Crescent, Sheffield, UK, S10 2BP.
Cochrane Database Syst Rev. 2011 Sep 7;2011(9):CD004665. doi: 10.1002/14651858.CD004665.pub3.
Cord drainage in the third stage of labour involves unclamping the previously clamped and divided umbilical cord and allowing the blood from the placenta to drain freely into an appropriate receptacle.
The objective of this review was to assess the specific effects of placental cord drainage on the third stage of labour following vaginal birth, with or without prophylactic use of uterotonics in the management of the third stage of labour.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (February 2010).
Randomised controlled trials comparing placental cord draining with no placental cord drainage as part of the management of the third stage of labour.
Two review authors independently assessed the quality of trials and extracted data. This was then verified by the third review author who then entered the agreed outcomes to the review.
Three studies involving 1257 women met our inclusion criteria. Cord drainage reduced the length of the third stage of labour (mean difference (MD) -2.85 minutes, 95% confidence interval (CI) -4.04 to -1.66; three trials, 1257 women (heterogeneity: T² = 0.87; Chi²P=17.19, I² = 88%)) and reduced the average amount of blood loss (MD -77.00 ml, 95% CI -113.73 to -40.27; one trial, 200 women).No incidence of retained placenta at 30 minutes after birth was observed in the included studies, therefore, it was not possible to compare this outcome. The differences between the cord drainage and the control group were not statistically significant for postpartum haemorrhage or manual removal of the placenta. None of the included studies reported fetomaternal transfusion outcomes and there were no data relating to maternal pain or discomfort during the third stage of labour.
AUTHORS' CONCLUSIONS: There was a small reduction in the length of the third stage of labour and also in the amount of blood loss when cord drainage was applied compared with no cord drainage. The clinical importance of such observed statistically significant reductions, is open to debate. There is no clear difference in the need for manual removal of placenta, blood transfusion or the risk of postpartum haemorrhage. Due to small trials with medium risk of bias, the results should be interpreted with caution.
分娩第三阶段的脐带引流是指松开先前已夹紧并切断的脐带，使胎盘血液自由流入合适的容器。
本综述的目的是评估胎盘脐带引流对阴道分娩后第三产程的具体影响，无论在第三产程管理中是否预防性使用宫缩剂。
我们检索了Cochrane妊娠与分娩组试验注册库（2010年2月）。
比较胎盘脐带引流与不进行胎盘脐带引流作为第三产程管理一部分的随机对照试验。
两位综述作者独立评估试验质量并提取数据。然后由第三位综述作者进行核实，之后将商定的结果录入综述。
三项涉及1257名女性的研究符合我们的纳入标准。脐带引流缩短了第三产程的时长（平均差（MD）-2.85分钟，95%置信区间（CI）-4.04至-1.66；三项试验，1257名女性（异质性：T² = 0.87；Chi²P = 17.19，I² = 88%）），并减少了平均失血量（MD -77.00 ml，95% CI -113.73至-40.27；一项试验，200名女性）。纳入研究中未观察到出生后30分钟胎盘残留的发生率，因此，无法比较这一结果。脐带引流组与对照组在产后出血或人工剥离胎盘方面的差异无统计学意义。纳入研究均未报告母婴输血结果，也没有关于第三产程中产妇疼痛或不适的数据。
与不进行脐带引流相比，进行脐带引流时第三产程的时长和失血量略有减少。这种观察到的统计学显著减少的临床重要性尚存在争议。在人工剥离胎盘、输血需求或产后出血风险方面没有明显差异。由于试验规模较小且存在中度偏倚风险，结果应谨慎解读。
