Re: Criminal Teaching on immediate cord clamping on an

From: Efrain Ramirez (eramirez@icepr.com)
Fri Mar 30 17:15:29 2001

>From The Cochrane Libary, Issue 1, 2001. Prepared and published by
Update Software Ltd. All rights reserved.

Active versus expectant management in the third stage of labour (Cochrane Review)

Prendiville WJ, Elbourne D, McDonald S

SYNOPSIS

Active management of the third stage of labour reduces blood loss and haemorrhage after birth.

The third stage of labour is that period from the birth of the baby until delivery of the placenta. Uterine muscles contract to stop maternal blood loss once the placenta separates. If this process does not work efficiently, the mother can haemorrhage. The review of trials found that active management of the third stage of labour, including drug administration, early cord clamping and controlled cord traction was more effective than expectant management, using none of these. Some of the drugs can cause side effects of nausea and vomiting. No effects were apparent for the baby.

ABSTRACT

A substantive amendment to this systematic review was last made on 09 March 2000. Cochrane reviews are regularly checked and updated if necessary.

Background: Expectant management of the third stage of labour involves allowing the placenta to deliver spontaneously or aiding by gravity or nipple stimulation. Active management involves administration of a prophylactic oxytocic before delivery of the placenta, and usually early cord clamping and cutting, and controlled cord traction of the umbilical cord.

Objectives: The objective of this review was to assess the effects of active versus expectant management on blood loss, post partum haemorrhage and other maternal and perinatal complications of the third stage of labour.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group trials register.

Selection criteria: Randomised trials comparing active and expectant management of the third stage of labour in women who were expecting a vaginal delivery.

Data collection and analysis: Trial quality was assessed and data were extracted independently by the reviewers.

Main results: Five studies were included. Four of the trials were of good quality. Compared to expectant management, active management (in the setting of a maternity hospital) was associated with the following reduced risks: maternal blood loss (weighted mean difference -79.33 millilitres, 95% confidence interval -94.29 to -64.37); post partum haemorrhage of more than 500 millilitres (relative risk 0.38, 95% confidence interval 0.32 to 0.46); prolonged third stage of labour (weighted mean difference -9.77 minutes, 95% confidence interval -10.00 to -9.53). Active management was associated with an increased risk of maternal nausea (relative risk 1.95, 95% confidence interval 1.58 to 2.42), vomiting and raised blood pressure (probably due to the use of ergometrine). No advantages or disadvantages were apparent for the baby.

Reviewers' conclusions: Routine 'active management' is superior to 'expectant management' in terms of blood loss, post partum haemorrhage and other serious complications of the third stage of labour. Active management is, however, associated with an increased risk of unpleasant side effects (eg nausea and vomiting), and hypertension, where ergometrine is used. Active management should be the routine management of choice for women expecting to deliver a baby by vaginal delivery in a maternity hospital. The implications are less clear for other settings including domiciliary practice (in developing and industrialised countries).

Citation: Prendiville WJ, Elbourne D, McDonald S. Active versus expectant management in the third stage of labour (Cochrane Review). In: The Cochrane Library, 1, 2001. Oxford: Update Software.

MeSH: Delivery/*methods; Female; Human; *Labor Stage, Third; Postpartum Hemorrhage/*prevention & control; Pregnancy

This is an abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).

The Cochrane Library is prepared and published by Update Software Ltd. All rights reserved.

See http://www.update-software.com or contact Update Software, info@update.co.uk, for information on subscribing to The Cochrane Library in your area.

Update Software Ltd, Summertown Pavilion, Middle Way, Oxford OX2 7LG, UK (Tel:+44 1865 513902; Fax:+44 1865 516918)

File Reference: ab000007-20011

At Fri, 30 Mar 2001, Donna Young wrote: >
>This is a copy of correspondence to the Department of Health, State of
>Illinoise
>I am posting this for a response of duty of care of the highest
>standards of medical practice and best practice possible. I therefore
>wonder why gynecologists are doing on Boards of Cord Blood Bank and have
>not given guideliens that protect the infant from what I call criminal
>assault on the infant by depriving the infant of full volume pressure
>and full volume of blood. That is all provided by the design and
>purpose of nature to give to the infant, at the time of its birth. The
>placenta continues to serve the infant for perhaps ten minutes,
>transfusing blood into the infant. DNA testing will confirm the cells
>of the blood and ownership of organ and blood, to be the infant's. So
>no medical person can legally deprive the infant of its legal rights to
>all what nature intended the owner to have. Please write me of any
>factual experiments, with parents awareness of consent, of facts that
>would stand up in a Court of Law, that immediate cord clamping is good
>medical practice, and how it serves an infant. To my knowledge, it is a
>practice that should NOT be routine, in c-sections and/or in vaginal
>deliveries. It is a practice only for last hope to save an infant's
>life. I see no logic in taking a infant off its lifeline, that is
>pulsating giving oxygenated blood and fluids to the infant. . . and
>rushing the infant to a machine that has not been wheeled to the
>distressed infant, and added to the treatment, all the while, the infant
>is receiving something of a benefit from its own pulsating lifeline.
>
>From: Donna Young, Box 504, Dawson Creek, BC V1G 4H4 tel/fax:250-782-9223
>
>> To Whom it May Concern,
>Department of Health, Illinois
>
>Subject: Unlicensed Midwife charge with a death of a still born? Yvonne
>Cyrn
>
>> You are invited to share some of my correspondence. I am age 59
>years,
>> I live in Northern British Columbia. My world comes to me on my
>computer.
>> . . I have a heart of interest for children. . . I do not like to see even
>> one harmed. . . not even my own, not others. . . Children are our future.
>. .
>> . We, being human, do make errors. When they have been pointed out. . .
>> those errors must be corrected, quickly. . . if the powers are within our
>> means.
> You are the State, you can act quickly. You can lead, where
>> Canada is lacking. . . you can put in a Moratorium. .on immediate cord
>> clamping that can wrongfully deprive the infant of its ownership of up to
>and over 50 percent of its valuable cord blood. That is being asked to
>be
>sent to cord blood banks, operating in almost every State, taking less
>then
>36 hours to airmail the infant's blood to them. No questions are being
>asked as to the medical operation resulting in the lost and deprived
>blood
>to the infant. Your citizens are being made weaker for that practice,
>with
>no questions asked.
> Ask me for my research, all by the efforts of others. . . who did
>not take their concerns to the Health Departments. . .as I have.
>There are over 55 pages of medical expert opinion that immediate cord
>clamping on the infant's pulsating umbilical cord is not healthy for the
>infant.
>
>Common sense should tell us that to start up a car without oil and gas
>in it, is not good practice. Same thing to start up the engine of a
>newborn
>infant without the blood and fluid lubrication to its heart, lungs,
>brain.
>No blood, and oxygen . . . you can assume dry spots, and some kind of
>damage, that may not be evident for days, weeks, years. . . but the
>infant
>is compromised. The costs of education go up and the costs of medical
>care
>go up. All unnecessary so. . . for a very unnecessary and unsound
>medical
>practice. . that must be immediately investigated, and who all is
>sending
>the infant cord blood to cord stem cell bloods. What insurance
>companies
>are paying for the collecting of the blood. . . secretly coded. . . as
>so-called approved medical procedures? Question the codes, check it out.

--
"Life is neither the notes nor the silence between the notes, but the music
that
  arises out of sound and silence felt as a living whole. Stop
choosing...between
  chaos and order, and live at the boundary between them, where rest and action
   move together..." David Whyte



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