COMPARISON OF OUTCOMES OF CONTROLLED CORD TRACTION VS SPONTANEOUS EXPULSION OF PLACENTA

Abstract

Background: The third stage of labor is associated with risks such as prolonged placental delivery, postpartum hemorrhage, and retained placenta. Controlled cord traction is an established component of active management of the third stage of labor, whereas spontaneous placental expulsion avoids traction and allows natural delivery of the placenta. Comparison of maternal outcomes associated with these approaches may help evaluate their effectiveness during vaginal delivery. Objectives: To compare the maternal outcomes of controlled cord traction versus spontaneous expulsion of the placenta during the third stage of labor. Study Design & Setting: This study was conducted in the Department of Obstetrics & Gynaecology, National Hospital, Lahore, Pakistan from 15 May 2026 to 15 August 2026. Methodology: A total of 200 women with singleton, cephalic pregnancies at ≥37 weeks planned for vaginal birth were included through non-probability consecutive sampling. Participants were randomly allocated into controlled cord traction (n=100) and spontaneous placental expulsion (n=100) groups. All participants received 10 IU intramuscular oxytocin after delivery. In the controlled cord traction group, traction was performed according to the WHO protocol, while in the other group the placenta was allowed to expel spontaneously. Duration of the third stage, blood loss, postpartum hemorrhage, retained placenta, manual removal, and change in maternal hemoglobin were assessed. Results: Mean third-stage duration was 6.84 ± 2.31 minutes in the controlled cord traction group versus 9.72 ± 4.16 minutes in the spontaneous group (p<0.001). Prolonged third stage occurred in 3.0% versus 10.0% (p=0.031). Mean blood loss was 286.40 ± 112.65 mL versus 342.70 ± 145.32 mL (p=0.003). PPH occurred in 5.0% versus 11.0% (p=0.123). Mean hemoglobin change was −0.49 ± 0.48 versus −0.67 ± 0.55 g/dL (p=0.015). Conclusion: Controlled cord traction was associated with shorter third-stage duration and lower blood loss, while differences in PPH and retained placenta were not statistically significant.