Objective: To compare the effects of AMTSL only, AMTSL without uterine massage, AMTSL with vacuum retraction cannula in prevention of post partum hemorrhage and to compare the effectiveness of vacuum retraction cannula with same pressure maintained at different duration of 5mins, 10 mins, 15 mins. Study  Design: Randomised comparison study. Setting: Labour ward of a tertiary care hospital,Government  Rajaji Hospital, Madurai. Participants: 100 patients in whom AMTSL only performed, 100 patients AMTSL performed without uterine massage, 100 patients in whom AMTSL with vaccum Retraction cannula performed. Methods: Informed and written consent was obtained from all patients who participated in this study. After dividing 300 participants into three study groups in AMTSL only group after delivery of the baby, inj Oxytocin 10 units IM given and then controlled cord traction done & placenta is removed. Uterine massage is done. In AMTSL without uterine massage group, AMTSL as in AMTSL only group with the exception of uterine massage is performed. In AMTSL with Cannula group, Along with AMTSL, Vacuum reraction cannula is applied in sequential manner and suction pressure of 650mmHg is maintained for 5,10,15 minutes. Finally in all three groups the blood loss was assessed using surgical drape. Outcome variable: various   grades of postpartum hemorrhage after cannula application. Results: Mean blood loss in routine AMTSL only group is 299.0 ml, in AMTSL with cannula group is 223.6 ml, in AMTSL without uterine massage group is 280.8 ml (p value < 0.001). in subgroups of AMTSL with cannula group where same pressure maintained at different durations of 5 mins,10 mins,15 mins, mean blood loss was 273ml if pressure was maintained for 5mins and 194 and 208ml if pressure was maintained for 10 and 15minutes respectively (p value 0.003). Conclusion: Vacuum retraction cannula significantly reduces the amount of blood loss and there by improves the grades of post partum hemorrhage as compared to AMTSL with or without uterine massage only and it also stops significant bleeding when applied for 10 and more minutes. 

Keywords: Post Partum Hemorrhage; Vacuum Retraction Cannula; AMTSL.