----- Original Message -----
Sent: Sunday, February 20, 2005 1:22
PM
Subject: Re: [ozmidwifery] question
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 -----
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
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
