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Re: Active management - third stage From: Raymond Stephen (stephen.raymond@dhhs.tas.gov.au) Wed Oct 12 19:43:18 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: RModugno@aol.com: "Re: Active management - third stage" Previous message: Anna Meenan, MD: "Re: OB: Fun and Games at 42w1d (long)" Maybe in reply to: RModugno@aol.com: "Active management - third stage" Next in thread: Efrain Ramirez: "Re: Active management - third stage" Reply: Efrain Ramirez: "Re: Active management - third stage" IV oxytocin works in 30 seconds, but IM takes three minutes. The difference is not clinically significant, but given IM the effect lasts longer and it is probably preferable. Potentially the drop in BP accompanying IV oxytocin is a disadvantage, but again not clinically significant. There is no argument that active management of the third stage is significantly effective in reducing PPH and in reducing the degree of drop in the Hb post delivery. This information is all available in the Cochrane Database. Not managing the third stage actively is asking for trouble. Syntometrine given IM is not likely to cause vomiting, nor is oxytocin, though nausea is sometimes a result. Steve Raymond -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Efrain Ramirez Sent: Thursday, 13 October 2005 2:41 AM To: Multiple recipients of list OB-GYN-L Subject: Re: Active management - third stage 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~ Tasmania Together 5 Year Review: Have your say http://www.tasmaniatogether.tas.gov.au/ Next message: RModugno@aol.com: "Re: Active management - third stage" Previous message: Anna Meenan, MD: "Re: OB: Fun and Games at 42w1d (long)" Maybe in reply to: RModugno@aol.com: "Active management - third stage" Next in thread: Efrain Ramirez: "Re: Active management - third stage" Reply: Efrain Ramirez: "Re: Active management - third stage"

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