Re: Active management - third stage
From: Efrain Ramirez (eramirezt@coqui.net)
Wed Oct 12 10:38:54 2005
BTW - how many of you give oxytocin in IV bolus.. there is a recent
article stating that there is no difference in maternal hemodynamics..
Ef
>At Wed, 12 Oct 2005, Robert J. Carpenter, Jr. MD wrote:
>
>The active management of third stage actually has a controilled prospective trial in
>England 12-15 years (or perhaps more now) and it had minimal downside. The blood
>loss was documented to be less. I'm sure for those who have access to Cochran you
>can pull it without difficulty.
>
>RJC
>
>On 12 Oct 2005 at 3:39, GA12L@aol.com wrote:
>
>> I used to work in a birth centre which was run by midwives only. We
>> always did physiological third stage unless the woman asked for
>> syntometrine (very few did). Part of our exclusion criteria was an
>> HB lower than 10 so none of our women were anaemic. This is what we
>> saw, admittedly it was only just over 400 women.
>>
>> Firstly, yes they bled heavily to begin with but that stooped within
>> 30 mins and then their blood loss was minimal. I have noticed in
>> women who have syntometrine that once the action wears off the
>> bleeding becomes heavier. Swings and roundabouts...
>>
>> Secondly, multips either had very mild or no afterpains.
>>
>> I have a problem with the term PPH. A woman who has an HB of 13 and
>> looses 600 mls is in a better position than a woman who has an HB of
>> 9.5 and looses 400 mils. Technically the first woman has had the PPH
>> but women with a good HB can lose a 1000mls and still not suffer any
>> ill effects.
>>
>> I now work in a hospital and unless the situation indicates I don't do
>> active management of the 3rd stage. The only PPH's I have seen have
>> been on women who have had syntometrine. If a woman's body is
>> capable of birthing her baby without any intervention why can't it
>> deliver the placenta the same way, without intervention.
>>
>> Syntometrine causes a woman's BP to rise and makes her feel nauseous
>> and can make her actually vomit does pitocin do the same?
>>
>> Gail
>>
>--
>Robert J. Carpenter, Jr. MD
>6624 Fannin, #2720
>St. Luke's Medical Tower
>Houston,TX 77030-2339
>713-795-4600
>
--
"Character may be manifested in the great moments, but it is made in the
small ones."
- Phillip Brooks
~walt whitman~
