Childbirth practices, protocols, or "standards of care"
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an urgent ongoing need

fetal to postnatal circulation





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Contact: Eileen Nicole Simon
Apgar scores of
8, 9, or 10
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
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