ABSTRACT
Over the past 40 years, there have been a number of review articles attempting to rationalise cord clamping practice. Early cord clamping was originally thought to be important in active management of the third stage of labour, but this was never evidence based. Without an evidence base to justify it, early cord clamping in clinical practice has remained very variable. There is good evidence that early cord clamping leads to hypovolaemia, anaemia and low iron stores in the neonate. We review all the evidence and discuss possible reasons why some obstetricians and midwives persevere with early clamping. We explain how a variable definition, defective education, deferred responsibility between obstetrician and paediatrician, variable guidelines and a lack of appreciation for the potential harm of the intervention, have all contributed. This study describes how the need for early cord clamping can be avoided in practically all clinical complications of birth.
Subject(s)
Delivery, Obstetric/methods , Umbilical Cord , Constriction , Female , Humans , Infant, Newborn , Labor Stage, Third , Midwifery/ethics , Midwifery/methods , Obstetrics/education , Obstetrics/ethics , Obstetrics/methods , Practice Guidelines as Topic , Pregnancy , Time FactorsABSTRACT
There is no consensus amongst medical and midwifery staff on the optimum time to cut the umbilical cord following childbirth. Studies have shown that delaying cord clamping for at least 30 seconds is associated with less need for blood transfusion and respiratory support. In 2004, Rabe et al. recommended delayed cord clamping for up to 120 seconds in preterm birth. The aim of our study was to ascertain whether or not obstetricians adopt this recommendation. Questionnaires were given to obstetricians from 43 different units in UK, other EU countries, USA, Canada, Australia etc. There was a 100% response rate. 53% adopted the recommendation only occasionally whereas 37% have never. Difficulty with implementation in clinical practice was the main reason for failure to adopt recommendation. Unawareness of the evidence of the benefits of delayed cord clamping was the reason in half of the non-compliant group. Obstetricians are reluctant to adopt the recommendation. Difficulty in clinical practice was the main reason. There is need for the Royal College of Obstetricians and Gynaecologists to produce guidelines for delayed cord clamping in obstetric practice.
Subject(s)
Attitude of Health Personnel , Delivery, Obstetric/methods , Premature Birth , Umbilical Cord/surgery , Constriction , Female , Humans , Pregnancy , Surveys and Questionnaires , Time FactorsSubject(s)
Colposcopy/methods , Uterine Cervical Neoplasms/pathology , Female , Follow-Up Studies , Humans , Prospective Studies , Vaginal SmearsSubject(s)
Biometry , Head/embryology , Female , Humans , Pregnancy , Reference Values , Ultrasonography, PrenatalSubject(s)
Gestational Age , Ultrasonography, Prenatal , Female , Humans , Pregnancy , Sensitivity and Specificity , Time FactorsABSTRACT
OBJECTIVES: To investigate how accurately practicing obstetricians (experts) can apply dating rules and compare the interpretation of gestation-sensitive ultrasound data with those of a computer system. SUBJECTS: Seventeen practicing obstetricians. Members of the Royal College of Obstetricians and Gynaecologists, from 14 different units throughout the UK. DESIGN: Six cases with menstrual and ultrasound data together with identical ultrasound charts and obstetric wheels. MAIN OUTCOME MEASURES: Concordance between the calculated estimated date of delivery (EDD) and growth assessment provided by the experts and the computer system. RESULTS: The calculation of the EDD by the experts was imprecise (59% within 3 days overall). Concordance with the computer calculation was poorest when the ultrasound measurements lay close to the upper or lower centile lines (average 7% within 3 days of the computer). Interpretation of growth showed good concordance with the computer when gestation was not critical to the interpretation (94%), but very poor when gestation was critical (7%). CONCLUSIONS: Calculation of EDD by means of an obstetric wheel and charts is not precise. Compared with the computer system, these errors have a significant effect on the subsequent interpretation of growth scans when the data are borderline. A computer system provides the more accurate method for interpreting gestation-sensitive ultrasound biometry.
Subject(s)
Data Interpretation, Statistical , Embryonic and Fetal Development , Fetus/anatomy & histology , Software , Ultrasonography, Prenatal , Anthropometry , Female , Humans , Labor, Obstetric , Menstruation , PregnancySubject(s)
Delivery, Obstetric , Fertilization in Vitro , Biometry , Female , Gestational Age , Humans , Pregnancy , Time Factors , Ultrasonography, PrenatalABSTRACT
A search of the two major journals of obstetrics and gynecology published in the United States has shown that the word abortion rather than miscarriage to describe early pregnancy loss is 6 times more likely to be used compared with most other English language journals over the last 5 years. The use of miscarriage, with descriptive adjectives such as threatened, incomplete, and complete, is recommended and the term delayed miscarriage is suggested in place of missed abortion.
