We welcome this review of active management of the third stage of labour concluding that oxytocin is the only effective element of the three components. We particularly welcome further (1) publicity for the removal of early cord clamping from active management. The authors reference evidence of harm to the neonate when the cord is clamped early, a practice which still remains common here in the UK and much of the rest of the developed world. Not only is oxytocin the only effective element in active management, a recent Cochrane review has shown that administration of oxytocin before or after the expulsion of placenta did not significantly influence the incidence of postpartum haemorrhage not any of the complications of the third stage. (2) The review was limited due to small studies and a large study would be needed to identify any optimal time for the oxytocic if this was considered important. Another Cochrane review supports the possibility that reducing the amount of blood in the placenta also reduces haemorrhage.(3) Draining the blood from the placenta from the cut cord or allowing it to drain into the neonate during transition is likely to have the same effect on residual placental volume.

References

1. Hutchon DJR Views and Reviews. Why do we still rush to clamp the cord. BMJ 2010;341:c5447

2.Soltani H, Hutchon DR, Poulose TA. Timing of prophylactic uterotonics for the third stage of labour after vaginal birth. Cochrane Database of Systematic Reviews 2010, Issue 8. Art. No.: CD006173. DOI: 10.1002/14651858.CD006173.pub2

3. Soltani H, Poulose TA, Hutchon DR. Placental cord drainage after vaginal delivery as part of the management of the third stage of labour. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD004665. DOI: 10.1002/14651858.CD004665.pub3.

Competing interests: None declared