RE: [ozmidwifery] question

Thu, 17 Nov 2005 20:56:31 -0800 

Liz
There is lots of research about cord gas analysis. Vast majority of it suggests it provides a good indication of how hypoxic a baby was at birth. Many hospitals use it to protect themselves against litigation. This is why the hospital I worked in had it as a policy - to reduce their insurance payments. So, you will be unlikely to argue that it is not an accurate measurement. 


BUT - you can argue that it does not protect against litigation. For 
example, a baby is born with apgars of 9 and at age 5 the parents decide 
that the childs learning disabilities are due to birth asphyxia. If the 
notes are dug out and the apgars are good and the birth was uncomplicated - 
they have no case. However, if there is a cord gas result indicating hypoxia 
= a different story. I have caught babies who have come out screaming and 
had bad cord gases and babies who required resus but had good gases. It is 
normal for a baby to get stressed. It depends on the individual baby as to 
how much hypoxia is too much. I dread to think what my sons cord gases were 
- 1 hour of pathological ctg, resus and grunting. But, he is fine.



It is also an invasive procedure and parents should give consent for it. How 
many parents make an informed choice about this procedure? Bearing in mind 
that if we identify your baby was hypoxic we can't go back and change 
anything.



I found that cord gas results became kind of 'practitioner test'. Some one 
else would put the blood through the computer and give you your exam 
results. If the result was poor - every one got to know and your practice 
was questioned.



I gave up trying to argue the point in the end. In my own practice I would 
only take cord blood if I felt it was clinically indicated eg. complicated 
birth or baby requiring resus.


The following article may help you:


Routine cord blood gas analysis: an overreaction? - Practising Midwife , vol 
7, no 10, November 2004, pp 20-23 Quek S - (2004)


Good luck

Rachel





From: "Elizabeth and Mark Bryant" <[EMAIL PROTECTED]>
Reply-To: [email protected]
To: <[email protected]>
Subject: RE: [ozmidwifery] question
Date: Fri, 18 Nov 2005 12:31:43 +1100

Rachel, i am preparing to do a talk to the midwives and possible obs at my
hospital at the moment on early vs delayed cord clamping, and one of the
main reasons they use to back up their routine practice of early cord
clamping is the need for routine cord blood analysis after EVERY birth. do
you know where i could get any info that might help back up the argument
against this? i have lots of info on the benefits of delayed cord clamping
but i know there will be lots of counter arguments...
Liz

-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] Behalf Of wump fish
Sent: Friday, 18 November 2005 11:49 AM
To: [email protected]
Subject: Re: [ozmidwifery] question


I agree with you Andrea. I think many babies are literally strangled during
true shoulder dystocias. As for cord ph - I can clearly remember a baby
having a lovely normal cord ph following his death during a shoulder

dystocia (????). Provided me with yet more ammunition against the 
hospital's

policy of routine cord gas analysis following all births.
Rachel


>From: Andrea Quanchi <[EMAIL PROTECTED]>
>Reply-To: [email protected]
>To: [email protected]
>Subject: Re: [ozmidwifery] question
>Date: Thu, 17 Nov 2005 17:22:52 +1100
>
>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
>>>----- Original Message -----
>>>From: Anne Clarke
>>>To: [email protected]
>>>Sent: Thursday, November 17, 2005 5:54 AM
>>>Subject: Re: [ozmidwifery] question
>>>
>>>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
>>>>----- Original Message -----
>>>>From: Susan Cudlipp
>>>>To: midwifery list
>>>>Sent: Wednesday, November 16, 2005 9:30 PM
>>>>Subject: [ozmidwifery] question
>>>>
>>>>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
>>>>
>>>>
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