I have dyed my hair red in the past…does
that impact also??? -----Original
Message----- As a red head, I am
curious about the evidence for the active management of third stage for red
heads! Jeannie Minnis -----Original
Message----- 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. 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 -- -- |
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