| Childbirth practices, protocols, or "standards of care" |
||||||||||||||||||||||||||||||||||||||||
| Home -------- Site Map Apgar Oxygen an urgent ongoing need Transition fetal to postnatal circulation Tradition >>Protocols Outcomes Concerns Question Authority References Links Notes Contact: Eileen Nicole Simon eileen4brainresearch@yahoo.com |
||||||||||||||||||||||||||||||||||||||||
| Apgar scores of 8, 9, or 10 |
Published protocol |
WAIT A MINUTE |
Cochrane Review |
Comments on the Cochrane Review |
||||||||||||||||||||||||||||||||||||
| << |
>> |
|||||||||||||||||||||||||||||||||||||||
| Slow birth |
||||||||||||||||||||||||||||||||||||||||
| The 1950 edition of William's Obstetrics states: |
||||||||||||||||||||||||||||||||||||||||
| "Whenever possible, clamping or ligating the umbilical cord should be deferred until its pulsations wane or, at least, for one or two minutes. |
||||||||||||||||||||||||||||||||||||||||
| There has been a tendency of late, for a number of reasons, to ignore this precept. In the first place the widespread use of analgesic drugs in labor has resulted in a number of infants whose respiratory efforts are sluggish at birth and whom the obstetrician wishes to Turn over immediately to an assistant for aspiration of mucus and, if necessary, resuscitation. This readily leads to the habit of clamping all cords promptly. Secondly, there is the episiotomy wound to suture; and the quicker the repair is started, the shorter will be the duration of anesthesia, and the less the blood loss from the wound. Finally, modern management of the third stage, especially if ergonovine has been given with the birth of the anterior shoulder, calls for immediate attention to the uterus and furnishes another reason for handing the baby to an assistant or nurse as promptly as possible. These three tendencies of modern obstetrics, then, notwithstanding their several merits, do militate against delayed clamping of the cord." – Eastman 1950, pp 397-398. |
||||||||||||||||||||||||||||||||||||||||
| >> |
||||||||||||||||||||||||||||||||||||||||
| In 1958, Apgar (and her colleagues) wrote that scoring at one minute was done because this represented the time of most severe depression: |
||||||||||||||||||||||||||||||||||||||||
| "In the Sloane Hospital the cord has been cut by this time, and the infant is in the hands of an individual other than the obstetrician. In many hospitals, such is not the case. Those obstetricians who practice slow delivery and delayed clamping of the cord until pulsations of the umbilical artery cease still have the infant in the sterile field. However, if the obstetrician is reminded of the passage of time by another observer, he may assign a score even though the cord is still attached," |
||||||||||||||||||||||||||||||||||||||||
| >> |
||||||||||||||||||||||||||||||||||||||||
| Posted: February 27, 2006 (a work in progress) |
||||||||||||||||||||||||||||||||||||||||
| Apgar et al.1958, p 1987 |
||||||||||||||||||||||||||||||||||||||||
| <<< 6a >>> |
||||||||||||||||||||||||||||||||||||||||
| >> |
||||||||||||||||||||||||||||||||||||||||
| top |
||||||||||||||||||||||||||||||||||||||||