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So I started reading the Cochran review after seeing hte link on another thread. Everything so far has really ligned up with what i think i knoiw, except this
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Active versus expectant management in the third stage of labour<br><br>
Active management of the third stage of labour reduces blood loss and haemorrhage after birth.<br><br>
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.</td>
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<a href="http://www.cochrane.org/reviews/en/ab000007.html" target="_blank">http://www.cochrane.org/reviews/en/ab000007.html</a><br>
Thoughts?
 

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The World Health Organization supports active management. I think the important thing is that it involves <i>controlled cord traction</i>, which means taking up slack in the cord so that you can identify separation and guide the placenta out once it's ready, NOT pulling on the placenta while it is attached. However, the primary outcome examined here is blood loss is length of third stage. "No apparent effects" on the baby is pretty nebulous since it doesn't tell us what effects they were looking for.
 

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The World Health Organization supports active management as preventative measure for hemorrhage. Postpartum hemorrhage is the number one cause of maternal death so prevention strategies are a major initiative for WHO. I think the important thing is that it involves <i>controlled cord traction</i>, which means simply keeping the cord pulled taught so that it comes on out when it separates, NOT pulling on the placenta while it is attached. However, the primary outcome examined here is blood loss and length of third stage. "No apparent effects" on the baby is pretty nebulous since it doesn't tell us what effects they were looking for.
 

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so lets look at what they boil it down to, and note that it was last updated 2000 so that was before many of the recent positive delayed cord cutting studies were published -- also other than one study I can think of they don't give time frames as to how long after birth is blood loss measured.<br>
below , I looked while replying to you and here is and abstract of the cochran review for delayed cord clamping-- which incidentally talks about active management -- so a 3 minute difference in that not quite 10 minute difference time frame is now a 6-7minute difference ---- also the Bristol study noted that the physiologic management babies were about 85gm heavier than the active management babies... could it be cord blood, and the number of babies that were put to breast is about 4 times greater than the active management group of babies.... couple that info with the info on successful breastfeeding-<br><br><br>
"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 1.83, 95% confidence interval 1.51 to 2.23), vomiting and raised blood pressure (probably due to the use of ergometrine). No advantages or disadvantages were apparent for the baby"<br><br>
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Cochrane Database Syst Rev. 2008 Apr 16;(2):CD004074.<br><br>
Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes.<br><br>
McDonald SJ, Middleton P.<br><br>
Midwifery Professorial Unit, Mercy Hospital for Women, Level 4, Room 4.071, 163<br>
Studley Road, Heidelberg, Victoria, Australia, 3084.<br><br>
BACKGROUND: Policies for timing of cord clamping vary, with early cord clamping generally carried out in the first 60 seconds after birth, whereas later cord clamping usually involves clamping the umbilical cord greater than one minute after the birth or when cord pulsation has ceased.<br>
OBJECTIVES: To determine the effects of different policies of timing of cord clamping at delivery of the placenta on maternal and neonatal outcomes.<br>
SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (December 2007).<br>
SELECTION CRITERIA: Randomised controlled trials comparing early and late cord clamping.<br>
DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial eligibility and quality and extracted data.<br>
MAIN RESULTS: We included 11 trials of 2989 mothers and their babies. No significant differences between early and late cord clamping were seen for postpartum haemorrhage or severe postpartum haemorrhage in any of the five trials (2236 women) which measured this outcome (relative risk (RR) for postpartum haemorrhage 500 mls or more 1.22, 95% confidence interval (CI) 0.96 to 1.55). For neonatal outcomes, our review showed both benefits and harms for late cord clamping. Following birth, there was a significant increase in infants needing phototherapy for jaundice (RR 0.59, 95% CI 0.38 to 0.92; five trials of 1762 infants) in the late compared with early clamping group. This was accompanied by significant increases in newborn haemoglobin levels in the late cord clamping group compared with early cord clamping (weighted mean difference 2.17 g/dL; 95% CI 0.28 to 4.06; three trials of 671 infants), although this effect did not persist past six months. Infant ferritin levels remained higher in the late clamping group than the early clamping group at six months.<br>
AUTHORS' CONCLUSIONS: One definition of active management includes directions to administer an uterotonic with birth of the anterior shoulder of the baby and to clamp the umbilical cord within 30-60 seconds of birth of the baby (which is not always feasible in practice). In this review delaying clamping of the cord for at least two to three minutes seems not to increase the risk of postpartum haemorrhage. In addition, late cord clamping can be advantageous for the infant by improving iron status which may be of clinical value particularly in infants where access to good nutrition is poor, although delaying clamping increases the risk of jaundice requiring phototherapy.<br><br><br>
PMID: 18425897 [PubMed - indexed for MEDLINE]
 

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