Cervical Traction (Amr Maneuver) Compared to Active Management for Third Stage of Labor

Preventing postpartum hemorrhage (PPH) remains a critical challenge in obstetrics, as it is a leading cause of maternal mortality worldwide. Current standard practice, known as active management of the third stage of labor, typically involves administering oxytocin and performing controlled cord traction (CCT) with uterine counter-pressure. While effective, there's ongoing research into alternative or complementary methods to optimize placental separation and reduce blood loss. This study investigates a novel cervical traction technique, the Amr maneuver, as a potential non-pharmacological adjunct or alternative to CCT.

This randomized controlled trial (RCT) will enroll 306 patients, dividing them into two groups. Both groups will receive an initial Oxytocin 10 IU I.V shot at the anterior shoulder delivery. The control group (153 patients) will then undergo active management of the third stage, including an additional Oxytocin 5 IU I.M and controlled cord traction (CCT) with the Brandt Andrews maneuver. The study group (156 patients) will have oxytocin stopped after the initial dose, and cervical traction (Amr maneuver) will be applied for approximately 90 seconds using ovum forceps to the anterior and posterior cervical lips, avoiding CCT and uterine massage.