Today our topic of discussion is Controlled Cord Traction.
Controlled Cord Traction
CONTROLLED CORD TRACTION
Steps Involved in Controlled Cord Traction (Fig. 33.8)
- Clamp the maternal end of the umbilical cord close to the perineum with a pair of forceps
- Hold this clamped end and the forceps with one hand
- Place the other hand just above the woman’s pubic bone.
- This is to stabilize the uterus by applying counter- traction (pressure in the opposite/upward direction) on the uterine fundus during controlled cord traction (CCT)
- Keep slight tension on the cord and wait for a strong uterine contraction
- When the uterus contracts, as will be evidenced by the uterus becoming hard and globular, or when the extravulval portion of the cord lengthens, gently pull downward on the cord to deliver the placenta.
- Continue to apply countertraction on the uterus with the other hand
- If the placenta does not descend within 30-40 seconds of CCT, i.e. there are no signs of placental separation, do not continue to pull on the cord
- The signs of placental separation are: The uterus becomes hard and globular (uterine contraction)
- The extravulval portion of the cord lengthens
- There is a sudden gush of blood when the placenta separates.
- If the fundus of the uterus is gently pushed up towards the umbilicus, the cord will not recede into the vagina
- Wait for the next uterine contraction and repeat CCT with countertraction
- As the placenta delivers, hold it with both hands to prevent tearing of the membranes
- If the membranes do not slip out spontaneously, gently turn the placenta so that the membranes are twisted into a rope and move them up and down to assist separation.
- If pulled at, the thin membranes can tear off and get retained in the uterus.
- If the membranes tear, gently examine the upper vagina and cervix and use your fingers or a pair of sponge forceps to remove any pieces of membrane that might be present.
- Remember, you should never apply cord traction (pull) without applying countertraction (push) above the pubic bone with the other hand.
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