Scientific Impact Paper 14
Active management of the third stage of labour became part of clinical practice in the 1960s, accompanying the widespread introduction of Syntometrine® (oxytocin plus ergometrine). It is associated with a reduction in the risk of postpartum haemorrhage when compared with physiological care. Prophylactic uterotonic drugs are a key component in this reduction. The importance of the other two components of active management: immediate (usually defined as within 20 seconds of birth) cord clamping and controlled cord traction, remains unclear. ‘Immediate’, rather than ‘deferred’, cord clamping is not universally accepted as part of the active management of the third stage of labour. A survey of policy at 1175 units in 14 European countries found that two-thirds clamp the cord immediately after birth, although 90% routinely administer prophylactic uterotonics. There was variation between countries, with 77% of UK units reporting that they used immediate cord clamping, compared with 15% in Austria and 17% in Denmark. The International Federation of Obstetrics and Gynecology and the World Health Organization no longer recommend immediate cord clamping as a component of active management. This Opinion Paper summarises the physiology of cord clamping, and reviews the evidence related to timing of clamping.
This Scientific Impact Paper can be downloaded as a pdf below:
An addendum published in April 2011 in Green-top Guideline 52 ‘Prevention and Management of Postpartum Haemorrhage’ contains new advice on the timing of cord blood clamping. To view the RCOG statement on the addendum, please click here.