Re: [ozmidwifery] question

[Susan Cudlipp]

Interesting! "usual" management where you are would seem to be what others would call "active" management, as opposed to physiological.   30 units syntocinon in one litre of hartmanns is what we use for PPH or those at high risk - again, dependant upon the doctor on duty - one that no longer works with us used to request  this management quite frequently, the others only seem to do it when there is PPH or an atonic uterus, twins, etc. Or may request it be ready in case for grand multips etc. But again, you practice waiting for signs of separation before CCT -  is this stated in your hospital policy?  I have tried looking in ours and it just states "Active management" without a step-by-step protocol as to what this should entail. Thanks for your input Sue   PS - HTH!  ??? ----- Original Message ----- From: JoFromOz To: ozmidwifery@acegraphics.com.au Sent: Sunday, February 20, 2005 3:19 PM Subject: Re: [ozmidwifery] question Susan, where I work we use Synometrine IMI, and are told to clamp the cord immediately - the drug is supposed to be given with the anterior shoulder, but is rarely given that soon... it is often given after the cord is clamped.  Then we await signs of separation before commencing CCT.  This is the usual management.... it is not called active management... Active management is when a bag of 30IU syntocinon in 500ml CSL is commenced after the syntometrine is given IMI, at a rate of 240ml/hr and titrated down according to loss.  Someone told me when I first started working there, "this woman is for active management of 3rd stage."  I said, "I thought that was policy anyway..."  "No, 30 units of synto in a 500ml bag is active management..."  That is used for anyone with a previous PPH or a grand multipara.  One of the private docs also uses that for red-headed women. Depending on which doctor is on how long before declaring 'retained placenta'.  HTH! Jo (RM) Susan Cudlipp wrote: Thanks for this, and for the feedback so far - I'm sure more is on the way! The situation is that I am contesting another practitioner's management of a delivery. One aspect of this delivery was that he commenced CCT on a friable cord (small baby- IUGR - scrappy cord) almost as soon as the oxytocic had been given (we use sytocinon not syntormetrine by the way Mary).  The cord, not surprisingly, separated.  And a chain of events ensued.... :-( I challenged the fact that CCT had been commenced before signs of separation, and was told that the only factor needed to be ascertained was that the uterus was contracted. I know that I was taught to await signs of separation before commencing CCT, even given that in those days we always used syntometrine,so this surprised me. As this situation is now being taken further (there is obviously a lot more to the whole story)  I need to have my facts and evidence to back up my opinion before the next stage.  Unfortunately it still seems to be that this issue is unclear with most centres recommending waiting, and some recommending immediate CCT with the first uterine contraction.  'Active management' is a term used frequently with, it seems, an assumption that people know what it entails.  I would be very interested to hear from student midwives on this - what exactly are you being taught nowadays? The second point of contention in this issue is what defines a retained placenta - I would have thought this was patently clear with most authorities agreeing that a period of 60 minutes is acceptable in the absence of bleeding.  As you will have guessed by now - this time was not given! Just for clarification, the patient had an empty bladder, an IVI with syntocinon infusion and was not bleeding.   Thanks again all Sue