Re: [ozmidwifery] question

[Jenny Cameron]

Active management of third stage using controlled cord traction. Beischer, N. Mackay, E. Purcal, N. 1989, 2nd edition. Care of the pregnant woman and her baby, W.B.Saumders/Balliere & Tindall, Sydney.   1) Administer oxytocic, Syntocinon 10 units IMI or IVI after the birth of the baby.   2) Await signs of separation.   3) The cord is reclamped near the vulva and steadied with one hand while the other hand is used to gently push the uterine fundus upwards. This will indicate if the placenta has separated since the cord will not follow the upward movement of the uterus. If separation has occurred, a combined movement is made of downward and backward traction on the cord and upward displacement of the uterus, provided that the latter is firmly contracted.   If the placenta does not advance there are usually only 2 possibilities - it is still attached to the uterus or it has become trapped in the tightly contracted uterus (unusual if using Syntocinon, usually only occurs with Ergometrine). In such cases be patient and repeat the procedure at intervals. Resist the temptation to massage the uterus unless bleeding is excessive. If the umbilical cord vessels are congested, remove the clamp and drain the cord blood out. This will reduce the size of the placenta.   Once the placenta appears at the vulva you can stop steadying the uterus and gently 'rock' the placenta out taking care not to tear the membranes. If they begin to tear, the placenta should be rotated to cause a bunching up of the membranes near the vulva; a wide clamp is then applied and the membranes eased out with steady traction (pp 252-3).   It is generally recommended to always use an oxytocic with controlled cord traction, however it can performed without an oxytocic as long as you await separation and ensure the uterus is firmly contracted before applying any traction. Hope this helps. Cheers Jenny Jennifer Cameron FRCNA FACM ProMid Professional Midwifery Education  Service 0419 528 717 ----- Original Message ----- From: Ken WArd To: ozmidwifery@acegraphics.com.au Sent: Sunday, February 20, 2005 8:41 AM Subject: RE: [ozmidwifery] question You must wait for placental separation, otherwise you risk inverting the uterus    Maureen -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of Susan Cudlipp Sent: Wednesday, 9 February 2005 2:55 AM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] question Dear ozmid list-ners I have not been on the list for a while but have a question that I would welcome your input on.   When performing active management of the third stage, is it routine practice to await signs of placental separation before commencing CCT, or to simply ascertain that there is uterine contraction?   Also, what is the current recommendation for management of retained placenta, or situations when the cord separates during CCT?   I know this may sound odd, and I know what I was taught and have practiced, but I am in the midst of a "difference of opinion" and I need to check what are the actual guidelines given.  I have attempted to search this out myself but have not been able to find much in the way of actual step-by-step instructions for active management of the third stage.   With respect, I do not need to know people's preferred methods or  opinions on the rights and wrongs of active management, simply the actual guidelines for active management and when to commence CCT.  I would be grateful if anyone can post this or lead me to it.  I have tried many sites on the net without success and do not have easy access to up to date manuals.   Thank you in advance, I have been "off list" for quite a while due to being very busy!  Looking forward to listening in again now that life is a bit quieter.   Susan  Cudlipp