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Q&A

Clinical Obstetrics

Poster Session 4

(1158) The placental drainage effect on quantitative blood loss after vaginal delivery in an urban population

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality. Placental cord drainage (PCD) is the unclamping of the umbilical cord to allow drainage of blood from the placenta, intended to minimize PPH. This technique has been studied predominantly among healthy patients, so this trial was designed to investigate the effect of PCD in a high-risk population.

Study Design:

We conducted a randomized controlled trial examining the impact of PCD prior to placental delivery on quantitative blood loss (QBL) in women ages 18 to 45 undergoing term vaginal delivery at a safety-net, county hospital in Memphis, TN. Women were randomly assigned to one of two groups: 1. PCD prior to placental delivery and 2. Immediate delivery of the placenta. Two-sided t testing and Mann Whitney U testing were used to compare QBL, change in hematocrit, and duration of third stage of labor, as appropriate. Analyses were performed on Stata version 16.1 (StataCorp, College Station, Texas).

Results:

Between January 2022 and January 2023, 49 total patients met inclusion criteria. 88.6% of participants identified as Black, and 79.2% of participants were enrolled in Medicaid insurance plans. The average body mass index was 34.1. The average gestational age at delivery was 39.0 weeks. There was no significant difference in baseline characteristics between groups (p >0.05 for all comparisons). At time of delivery, 21 (42.9%) patients underwent placental drainage and 28 (57.1%) did not. The average QBL was 273.3 mL in group 1 and 377.8 in group 2 (p=0.01).  The average percent change in hematocrit before and after delivery was -3.2% in group 1 versus -3.5% in group 2 (p=0.71). There was no significant change in the average duration of the third stage of labor (5.8 minutes in group 1 versus 7.4 minutes in group 2; p=0.95).

Conclusion:

PCD is a low cost, simple intervention that may be utilized to reduce average QBL after a vaginal delivery in high-risk populations.