Re: [ozmidwifery] question

[Andrea Quanchi]

You only have to watch the colour change to the head to know whether circulation is compromised or not. Some ( most ) babies stay pink and or only slightly dusky but others go almost navy blue and even get subconjuntival haemorrhages similar to those that occur in hanging victims which to me indicates that circulation to the head has been compromised for at least some time. Babies can tolerate this for a period but eventually it must have an effect. Just from observation I would say this has little to do with cord compression but compression of the foetal neck by maternal structures which would occur more severely in true shoulder dystocia. Of course prevention is better than cure and encouraging 25% increase in space within the maternal pelvis is likely to reduce the number of cases where this will be a problem.

Andrea Quanchi
On 17/11/2005, at 4:02 PM, Susan Cudlipp wrote:

Good point Anne!
 
I did quite a thorough search last night and have printed off some good articles which I will pass on.  However I could not find the answer to why EXACTLY babies die in shoulder dystocia.  If it is asphyxia, then (obs point of view) this proves that the cord is not sustaining them. The ob said to me that if the cord WERE sustaining them there would be no urgency to deliver the body, also quoted from the ALSO course that the fetal Ph drops 0.04 (?)  per minute after delivery of head therefor we should not be waiting for restitution but delivering body ASAP.  (I didn't even go there!!)
My feeling is that it is more to do with probable cord compression, (although I cannot picture why this should necessarily be so as the body and hence, presumably, the cord, would still be above the pelvic brim) and trauma to the neck usually caused by mis-management (panic) in trying to deliver the shoulders than asphyxia, but it is true that they become asphyxiated within a short time if truly stuck.  Any answers on that one?
Thanks
Sue
 
"The only thing necessary for the triumph of evil is for good men to do nothing"
Edmund Burke

<x-tad-bigger>----- Original Message -----</x-tad-bigger>
<x-tad-bigger>From:</x-tad-bigger><x-tad-bigger> </x-tad-bigger><x-tad-bigger>Anne Clarke</x-tad-bigger><x-tad-bigger> </x-tad-bigger>
<x-tad-bigger>To:</x-tad-bigger><x-tad-bigger> </x-tad-bigger><x-tad-bigger>ozmidwifery@acegraphics.com.au</x-tad-bigger><x-tad-bigger> </x-tad-bigger>
<x-tad-bigger>Sent:</x-tad-bigger><x-tad-bigger> Thursday, November 17, 2005 5:54 AM</x-tad-bigger>
<x-tad-bigger>Subject:</x-tad-bigger><x-tad-bigger> Re: [ozmidwifery] question</x-tad-bigger>

Dear Susan,
 
You could say to them if this is so why do they rely so much on cord ph's ?  One would think when the baby was born and the pulsating cord was still not supplying the baby effectively the cord blood (venous and arterial) was null and void to provide an estimation of oxygenation for the babe.
 
Regards
Anne Clarke
Queensland

<x-tad-bigger>----- Original Message -----</x-tad-bigger>
<x-tad-bigger>From:</x-tad-bigger><x-tad-bigger> </x-tad-bigger><x-tad-bigger>Susan Cudlipp</x-tad-bigger><x-tad-bigger> </x-tad-bigger>
<x-tad-bigger>To:</x-tad-bigger><x-tad-bigger> </x-tad-bigger><x-tad-bigger>midwifery list</x-tad-bigger><x-tad-bigger> </x-tad-bigger>
<x-tad-bigger>Sent:</x-tad-bigger><x-tad-bigger> Wednesday, November 16, 2005 9:30 PM</x-tad-bigger>
<x-tad-bigger>Subject:</x-tad-bigger><x-tad-bigger> [ozmidwifery] question</x-tad-bigger>

I have a question for you wise ozmidders.
I was having a discussion today with one of our obstetricians regarding cord clamping, and the benefits to the baby of delaying this until pulsations cease.  When I mentioned the benefit of the baby recieving oxygenated blood via the pulsating cord which could assist it's transition to independent respiration particularly if it was compromised (etc etc)  the obs was of the view that the pulsations could NOT be providing oxygenated blood because the uterus would have contracted down and the placenta could no longer be getting oxygen from mother's circulation.
Now I know that I have read reams on this and this is stated to be one of the benefits, but I could not answer that particular question physiologically and convincingly.
The point was also raised that in shoulder dystocia, babies die of asphyxiation, which (obs opinion) would not happen if they were recieving oxygen via the cord. 
I did print off George Morley's excellent papers for this Dr to read but would very much welcome anything that can show that the baby would still be receiving oxygenated blood post birth.
 
TIA
Sue
 
 
"The only thing necessary for the triumph of evil is for good men to do nothing"
Edmund Burke


__________ NOD32 1.1289 (20051116) Information __________

This message was checked by NOD32 antivirus system.
http://www.eset.com

No virus found in this incoming message.
Checked by AVG Free Edition.
Version: 7.1.362 / Virus Database: 267.13.3/173 - Release Date: 16/11/2005