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Controlled cord traction

Active management of the third stage.

Source: NICE NG235

Steps

  1. After uterotonic and signs of separation (globular uterus, cord lengthens, gush of blood).
  2. Hand above symphysis guards the uterus (counter-traction).
  3. Steady downward traction on the cord.
  4. Deliver placenta; ease membranes out by twisting.
  5. Check placenta and membranes complete; rub up the fundus.
Never pull without counter-traction or on a soft uterus — risk of inversion.
A summary for trained clinicians. Always check the full guideline, the patient in front of you and your hospital's protocol. Spotted an error? Tell us.