Bibliographic information
GuidelineConsolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage
Year of Publication2025
Issuing InstitutionWorld Health Organization
Recommendation
New
Controlled cord traction is the recommended method for removal of the placenta in caesarean section
Recommended
Notes and Remarks
- Cord traction at caesarean section refers to the gentle and steady pulling on the umbilical cord to assist removal of the placenta and membranes, after uterine incision and delivery of the baby.
- Cord traction in this context is preferred over manual removal of the placenta because it is associated with a lower risk of postoperative infection, particularly endometritis.
- Manual removal of the placenta may be necessary if the placenta does not separate spontaneously within a reasonable time or if cord traction is ineffective or unsafe.
- Cord traction should be performed under direct visualization of the uterine cavity and with concurrent uterotonic administration to promote uterine contraction and minimize blood loss.
- Proper training in technique and infection prevention, and readiness to manage complications (e.g. retained placenta or uterine atony), is essential for safe implementation.