1. The effect of cord blood drainage in the duration of the third stage of the labor Soheila Nazarpour, Islamic Azad university, Chalous Branch. Chalous. Iran Sima Nazarpour, Islamic Azad university, Varamin-Pishva Branch. Tehran. Iran Introduction Management of third stage can directly influence important maternal outcomes such as blood loss, need for manual removal of the placenta, postpartum hemorrhage, general anesthesia and blood transfusion.There have been several studies and suggestions of how to manage the third stage of labor and its shortening. One of these suggestions has been the drainage of placental blood after the cutting of the umbilical cord in order to accelerate the separation of placenta and to shorten the third stage of labor. Placental cord drainage involves the clamping and cutting of the umbilical cord after delivery of the baby but, afterwards, immediately unclamping the maternal side of the cord and allowing the blood to drain freely. There has been a research by Solitani and colleagues in 2005 in this field. In this research in which 147 cases were studied, detected a significantly shorter third stage of labor in the group that had cord drainage compared with controls (weighted mean difference -5.46, 95% CI -8.02 to -2.90). Despite limitations in these studies, cord drainage appears to be effective and is unlikely to be harmful as long as the cord is not clamped too soon.But an other research by Thomas and colleagues in 1990 in Quiziland in which 1,908 women were studied, showed that when the third stage of labor is actively managed, placental drainage of cord blood confers no extra benefits. One study by Giacalone et al randomly assigned 477 low risk women at term to placental cord drainage and cord traction or to expectant management in the third stage of labor. Cord drainage was found to have significant benefits in reducing the number of placentas retained at 30 minutes after birth (RR 0.28, 95% CI 0.10-0.73). No significant differences in incidence of manual removal of placenta or postpartum hemorrhage were noted. The authors concluded that cord drainage combined with careful traction was preferable to expectant management and may therefore be an alternative to routine oxytocin administration in women at low risk of postpartum hemorrhage.An other randomized controlled trial by Shravage and Silpa was carried out on 200 pregnant women. The objective was to evaluate the effectiveness of placental blood drainage via the umbilical cord in reducing the duration of blood loss in third stage of labor, and the incidence of postpartum hemorrhage. In the study group the placental end of the cut umbilical cord was unclamped immediately after it was cut and in the control group it remained clamped. Placenta was delivered by controlled cord traction. Intravenous methergin was given after delivery of placenta in both the groups. The duration of third stage and the amount of blood were noted. Results showed in the group that had cord drainage compared with controls,the duration of third stage was shorter (P<o.oo1)., the average third stage blood loss was less (P<o.oo1) and the incidence of postpartum hemorrhage was decreased in the study group ( 3% vs 10% ). Because of limited researches and their paradoxical results in the cases of the effect of umbilical cord blood drainage on the third stage of labor, the present research aims at the determination of the effect of placental blood drainage from the umbilical cord on the third stage of labor. Materials and Methods In this study which is a semi-experimental study, 120 women who have had normal vaginal delivery have been selected. The sampling group includes all the women that have come to one of the hospitals affiliated to the university of Iran medical sciences, and after acceptance have had normal delivery in lithotomy position. The criteria to accept the samples in this study were such as: single pregnancy, the fetus being alive until delivery and normal delivery with cephalic presentation. In all cases the placentas had normal adhesiveness and there had been no abnormal background affecting the duration of the third stage of labor. In this research 120 women representing the society of research and having all the characteristics of the research units were put into control and drainage groups. Sampling was done randomly. At different times, in the morning, in the evening and at night sampling was done. Thus the qualified women who had come to the mentioned hospital for delivery during one and a half months of sampling and had normal delivery took part in the research. From 120 participants, 60 women were randomly put in the control group and 60 were put in the drainage group. So that from the beginning of sampling the first one who was brought to the delivery room was put in the control group and the second one was put into the drainage group to the end of sampling, they were assigned randomly to two groups. The criteria to discard any sample were such as: the fifth delivery or more, pregnancy less than 37 weeks, preeclampsia or eclampsia, Hydramnios, taking sedative or an aesthesia during delivery, previous placental retention, previous caesarean section or any previous scar on the uterus, previous curettage, abnormal adhesiveness of placenta, placenta previa or placental abruption advised by the physician or midwife, abnormalities or abnormal cases such as fibroma and uterus tumors and dystocia diagnosed by physician. The data have been collected through direct observation, question and answer and using their records. The collecting devices in this research included the record paper, coronometer watch, scales and centimeter. To validate scientifically the data collection, the content validation was used and to determine scientific reliability the parallel amount method was used. In the cases of measurement devices including scale, watch and centimeter, the same devices were used for measurement and in all cases the scale was checked before its use for its adjustment. The method to use the devices was in such a way that first the patients records were studied before delivery and the necessary point were recorded in the record paper. The researcher was present at the of the delivery and recorded the necessary points. The patients who received oxytocin with serum before delivery, their serum was truncated at the time of delivery. In all the cases in two groups after delivery, the umbilical cord was closed and cut off. In the drainage group after cutting off, the umbilical cord was opened and the placental blood was drained through the umbilical cord. In none of the two groups in the third stage the uterus was not tampered and there has been no tension on the top of the uterus. In all of the cases with separation symptoms appearing and placenta descent, placenta was extracted through Brand`t Andrews manoeuvre. After the delivery of placenta, the weight of the fetus and placenta was measured through the scale. The length of umbilical cord and the diameter of placenta and its membranes were checked for its completeness. The patients were under observation for their bleeding and possible side effects and the necessary points were recorded. The data showed that the samples were similar in all the characteristics except to the weight of the placenta. The t-test of two groups showed that the mean of the placenta weight in the control group was significantly different from the drainage group (p<0/01, t=2/573). After the approval of the homogeneity of the groups in their characteristics, the duration of the third stage of labor in two groups as a whole and on the basis of each of their characteristics in the research have been compared with each other through variance analysis and t-test. Results The results obtained through this study shows that the method of placental blood drainage from umbilical cord has had no effect on the duration of the third stage of labor. The comparison between the means of the duration of the third stage of labor in control and drainage groups shows no significant statistical difference (t=0/232). In the cases of delivery consequences, there has been no significant difference in two groups and the intervention by placental blood drainage from umbilical cord has resulted in no side effect in the third stage of labor. Diagram - The mean of the duration of the third stage of labor in two groups of control and drainage Discussion In this research the effect of placental blood drainage from umbilical cord on the duration of the third stage of labor has been determined and compared. So that at the beginning for homogeneity, the characteristics and possible factors that can affect the third stage of labor in two groups of control and drainage have been determined and compared. These characteristics are such as: age, number of previous pregnancies, number of previous deliveries, abortion background, taking oxytocin during delivery, the duration of the first stage of labor, the duration of the second stage of labor, tension on the top of the uterus, analgesia for episiotomy, the mechanism of placental extraction, placental abnormality, fetal weight, the length of umbilical cord, placenta weight and placenta diameter. The findings showed that both groups were homogeneous generally in their characteristics, except to the placenta weight which was significantly different in control and drainage groups. Thus if the factors presented, were effective on the duration of the third stage of labor, the effect would be the same in both groups. After studying the homogeneity of the groups, to determine the general objective of the research, using analytical statistical test, both groups were compared with each other for the duration of the third stage of delivery. The findings obtained from the analytical statistics between the mean of the duration of the third stage of labor in two groups indicated that there was no significant difference between the mean of the duration of the third stage of drainage group and control group. Thus it was made clear that the method of placental blood drainage from umbilical cord has no effect on the duration of the third stage of labor, so that the hypothesis of the research is discarded. This finding is in agreement with the idea of Thomas, et al (1990) who have declared their idea after their research: placental blood drainage from umbilical cord has no effect on the easiness of placental extraction but no side effect has been mentioned there. In this research, comparing the delivery consequences in both groups, there has been no specific side effect in the drainage group compared with control group. But the result obtained is in contradiction with the findings obtained in the study of Soltani, et al; Giacalone, et al; Shravage and Silpa. Therefore we need more researches in this field. References 1. Cunningham FG, Gant NF, Leveno KJ, et al. Conduct of normal labor and delivery. In: Williams Obstetrics. 21st ed. New York, NY: McGraw-Hill; 2001: 320-5. 2.Wingeier R, Griggs R. Management of Retained placenta using intraumbilical oxytocin injection. Journal of nurse- midwifery 1991; 36: 240-244. 3.Prendiville WJ, Elbourne D, McDonald S. Active versus expectant management in the third stage of labour (Cochrane Review). In: The Cochrane Library, Issue 2. Oxford, UK: Update Software. 2002. 4.Herman,A.complicated third stage of labor: time to switch on the scanner. Ultrasound Obstet Gynecol 2000; 15:89. 5. Razmkhah, N, Kordi, M, Yousophi, Z, et al. The effects of cord drainage on the length of the third stage of labor. Scientific Journal of Nursing and Midwifery of Mashad University 1999; 1:10. 6. Soltani H, Dickinson F, Symonds I. Placental cord drainage after spontaneous vaginal delivery as part of the management of the third stage of labour. Cochrane Database Syst Rev.2005;CD004665. 7.Thomas I.L, et al. Does cord drainage of placental blood facilitate delivery of placenta?. Australian Newzealand journal Gynaecolgy. 1990; 30: 314-318. 8.Giacalone,PL,Vignal,J,Daures,JP,Boulot,P. A randomised evaluation of two techniques of management of third stage of labor in women at low risk of postpartum hemorrhage. BJOG 2000 ; 107: 396 9. Shravage JC and Silpa P. Randomized controlled trial of placental blood drainage for the prevention of postpartuh hemorrhage, The Journal of Obstatrics and Gynecology of India. 2007; 57(3) : 213-215.