International Journal of Gynecology and Obstetrics (2006) 94 (Supplement 2),S126---S127 www.elsevier.com/locate/ijgo Controlled cord traction in the third stage of labor. Systematic review Fernando Althabe a, *, Eduardo Bergel a , Pierre Buekens b , Claudio Sosa a , José M. Belizán c a Perinatal Research Unit, Hospital de Clínicas, Piso 15, Av. Italia s/n, Montevideo CP11600, Uruguay b Tulane School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2430, New Orleans, LA 70112, USA c Institute for Clinical Effectiveness and Health Policy (IECS), Viamonte 2146 (3er Piso), (C1056ABH) Buenos Aires, Argentina Active management of the third stage of labor is the current standard evidence-based recommenda- tion for the management of the third stage of labor to prevent postpartum hemorrhage (PPH) [1]. De- spite the beneficial effects of active management as a whole, it is important to assess the effects of its individual components (uterotonic agents, late cord clamping, controlled cord traction (CCT), and uterine massage) in order to use and recommend the simplest, most effective, efficient, and safe in- tervention. CCT is promoted without solid evidence of its effectiveness, while its safety is uncertain. The CCT technique currently used and recom- mended was described by Spencer, as a modifica- tion of the Brandt-Andrews technique [2]. The tech- nique consist of elevating the uterus suprapubically while maintaining steady traction on the cord and not waiting for clinical signs of placental separa- tion. Through a systematic bibliographic search in Medline and in Cochrane CENTRAL, we found only * Corresponding author. Tel.//Fax: +598 2 486 4175. E-mail: althabef@gmail.com (Fernando Althabe). 0020-7292/$ --- see front matter © 2006 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. two published trials that evaluated the effects of CCT alone and not combined with other procedures. Both trials were conducted in hospital settings in the UK and Australia between 1962 and 1964, in women receiving intramuscular uterotonics to man- age the third stage of labor, and compared CCT (us- ing Spencer technique) with fundal pressure. Bonham studied 1192 patients having vaginal de- liveries [3]. The allocation method was a random two-week group for each method of placental deliv- ery. Kemp conducted a similar trial among a sample of 713 low-risk patients having single vaginal spon- taneous deliveries [4]. The patients were allocated into two groups according to age, with odd num- bers assigned to one group and even numbers to the other. A summary of the main outcomes are shown in Table 1. Summarizing the results of both trials, the ob- served effects of CCT on PPH are clinically hetero- geneous, with one showing a protective effect [3] and the other showing no effect [4]. There were no observed effects on mean blood loss and manual re- moval of placenta or curettage. From a methodological point of view, both tri- als present serious flaws. The methods of allocation