Placental separation is usually an orderly multiphasic phenomenon that begins mostly from the lower pole of the placenta and propagates sequentially upwards. Fundal placentae, however, separate first at their poles with the fundal part being separated last. Recognition of the sequence of events and understanding of the mechanism of placental separation may aid in detecting cases prone to third-stage complications and in managing pathological ones.
On a cold morning in October 1993, Gordon Guyatt, a young faculty member at McMaster Medical School in Hamilton, Ontario, found a brochure published by the American College of Physicians (ACP) in his mailbox bearing this title: In This Era of Evidence-Based Medicine! (personal communication). For Guyatt, who had coined the term nearly 3 years earlier in a short editorial for the ACP Journal Club, the copywriter's blunt assertion proved not to be an exaggeration [1]. Over a short period, evidence-based medicine, defined as "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients" [2], had evolved into an emblem for an entire generation, becoming synonymous with the practices of quantification and statistics that pervaded the medical milieu at the end of the twentieth century. Indeed, an era of evidence-based medicine (EBM) had been ushered in.
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