Bibliographic information
GuidelineConsolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage
Year of Publication2025
Issuing InstitutionWorld Health Organization
Recommendation
New
In settings where skilled birth attendants are unavailable, controlled cord traction is not recommended.
Not recommended
Notes and Remarks
- This recommendation is based on a large randomized controlled trial in which oxytocin 10 IU was used for the prevention of PPH in all participants. Based on this evidence, CCT was regarded as safe when applied by skilled birth attendants because it provides small beneficial effects on blood loss (average reduction of 11 mL on blood loss) and on the duration of the third stage of labour (average reduction of 6 minutes). The decision to implement CCT in the context of a prophylactic uterotonic drug should be discussed by the care provider and the woman herself before or early in labour.
- CCT should only be performed by personnel trained in its correct and safe use. When improperly performed, CCT carries a risk of complications, such as uterine inversion or retained placenta.
- In the absence of skilled birth attendants, expectant management of the third stage of labour is preferred, along with administration of a prophylactic uterotonic.
- There is insufficient evidence to determine the benefit or risk of CCT when used in conjunction with misoprostol.
- CCT is the first intervention to treat the retained placenta; therefore, the teaching of CCT in medical and midwifery curricula is essential.
- Based on the most recent evidence, the understanding of 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 an 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.