| Childbirth practices, protocols, or "standards of care" |
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| 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 |
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| Apgar scores of 8, 9, or 10 |
Published protocol |
WAIT A MINUTE |
Cochrane Review |
Comments on the Cochrane Review |
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| Slow birth |
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| Apgar et al. also wrote in the 1958 paper: |
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| “All infants with a score of 8, 9,or 10 are vigorous and have breathed within seconds of delivery. In this group, scores of 8 or 9 reflect a lower score for color. The infants with a score of 4 or less are blue and limp and have failed to establish respiration by one minute.” p 1987 |
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| Thus, in contrast to the opinion expressed by White in 1773, it is expected that the transition from fetal to neonatal respiration should take place within seconds of delivery. Despite much evidence that respiratory distress in the newborn period results from cutting off placental respiration too soon, clamping of the umbilical cord within seconds of delivery is still practiced half a century later. The 2005 edition of William's Obstetrics provides the following instruction: |
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| "Clamping the Cord. The umbilical cord is cut between two clamps placed 4 to 5 cm from the fetal abdomen, and later an umbilical cord clamp is applied 2 to 3 cm from the fetal abdomen. A plastic clamp (Double Grip Umbilical Clamp, Hollister) that is safe, efficient, and fairly inexpensive is used at Parkland Hospital..." |
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| "... Our policy is to clamp the cord after first thoroughly clearing the airway, all of which usually requires about 30 seconds. The newborn is not elevated above the introitus at vaginal delivery or much above the maternal abdominal wall at the time of cesarean delivery." |
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| From chapter 17, section IV, online version |
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| The above policy was based on opinions voiced in one article (from 1974) that placental transfusion raised the risk for hypervolemia and hyperbilirubinemia, especially in infants born prematurely - see full excerpt below. |
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| Posted: February 27, 2006 (a work in progress) |
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| <<< 6b >>> |
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