From the Guidelines
The umbilical cord may detach from the placenta during attempts to remove the placenta after birth due to excessive traction, improper technique, or underlying physiological and mechanical factors, and to minimize this risk, manual removal of the placenta should be avoided except in cases of severe and uncontrolled hemorrhage, as recommended by recent guidelines 1. The connection between the cord and placenta is relatively fragile compared to the placenta's attachment to the uterine wall, making it susceptible to detachment when excessive traction is applied during the third stage of labor. Key factors contributing to cord detachment include:
- Abnormal placental implantation, such as placenta accreta
- Congenital weakness in the cord-placental junction
- Cord anomalies
- Improper technique, such as pulling too forcefully without counter-pressure on the uterus above the pubic symphysis Given the potential risks, including post-partum hemorrhage, the latest guidelines suggest that manual removal of the placenta should not be carried out outside of a specialized structure, except in the event of severe and uncontrollable post-partum hemorrhage, in which case the administration of tranexamic acid may be beneficial 1. To prevent cord detachment and its complications, healthcare providers should prioritize gentle, controlled cord traction, support the uterus, and wait for signs of placental separation before applying traction, considering the administration of uterotonics like oxytocin to promote natural placental separation, as supported by the most recent guidelines for managing urgent obstetric situations 1.
From the Research
Reasons for Umbilical Cord Detachment
- The exact reasons for umbilical cord (UC) detachment during placental removal after birth are not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, studies suggest that umbilical cord drainage after vaginal delivery can reduce the length of the third stage of labor and the average amount of blood loss 3, 4.
- Umbilical cord drainage is thought to cause the collapse of thin-walled uteroplacental vessels, leading to earlier separation of the placenta 4.
- The World Health Organisation recommends dry cord care in countries with adequate obstetric care and low neonatal mortality rate 5.
- Abnormalities of the umbilicus, such as benign granulomas or persistent remnants, can change the normal course of cord separation and may be associated with significant morbidities if left unrecognized and uncorrected 6.
Possible Factors Influencing UC Detachment
- The mechanical conduit function of the umbilical cord between the fetus and placenta may play a role in its detachment during placental removal 2.
- The use of uterotonics in the management of the third stage of labor may also influence UC detachment 3.
- The technique of umbilical cord drainage, including the release of the cord clamp and the emptying of blood from the placenta, may affect the detachment of the UC 4.