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 available, controlled cord traction (CCT) is recommended for vaginal births if the care provider and the parturient woman regard a small reduction in blood loss and a small reduction in the duration of the third stage of labour as important.
Context specific recommendation
Only in specific contexts
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, controlled cord traction (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 skilled birth attendants who are trained in its correct technique. Incorrect use of CCT can increase the risk of uterine inversion or retained placenta.
- This recommendation does not apply in settings where skilled health personnel are not available or not trained to perform CCT safely.
- 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.
- The benefits of CCT may be more relevant in high-volume facilities where even small time savings in thirdstage management may contribute to workflow efficiency.