Re: Active management - third stage
From: Efrain Ramirez (eramirezt@coqui.net)
Wed Oct 12 20:15:27 2005
Agree...I am very agressive in the third stage --- prompt action is key
-- I think that uterine massage is not taken seriously enough - I have
seen it work many times - if given early on...
Ef
>At Wed, 12 Oct 2005, Raymond Stephen wrote:
>
>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/
>
--
"Character may be manifested in the great moments, but it is made in the
small ones."
- Phillip Brooks
~walt whitman~
