Pharmacologic management and controlled cord traction in the third stage of labour

Active management of the third stage of 62 944 labours over a period of 15 years (1970-84) constituted an intramuscularly administered combination of ergometrine (0.2 mg) and oxytocin (5 units), and controlled cord traction as mechanical assistance in delivery of the placenta. By these means manual removal of the placenta was performed in 0.67% of all deliveries, uterine inversion was found in 5 cases (1 in 12 588 deliveries) and blood transfusion necessary in 1.67% of all deliveries during puerperium. Oxytocin injection of 40-100 units into the umbilical vein of the retained placenta was performed in 40 cases. In 12 (30%) of these cases the placenta was separated by this new method. Previous use of intrauterine devices was a new etiological factor in the abnormally adherent placenta.