There was a small reduction in the length of the third stage of labour and also in the amount of blood loss when cord drainage was applied compared with no cord drainage. The clinical importance of such observed statistically significant reductions, is open to debate. There is no clear difference in the need for manual removal of placenta, blood transfusion or the risk of postpartum haemorrhage. Due to small trials with medium risk of bias, the results should be interpreted with caution.
The rationale for keeping the mother and her newborn together even when neonatal resuscitation is required is presented. The development of a customised mobile resuscitation trolley is detailed explaining how the resuscitation team can be provided with all the facilities of a standard resuscitation trolley to resuscitate the neonate at the mother’s side with an intact cord. Alternative low tech solutions which may be appropriate in low resource setting and with a low risk population are also described.
During labour the fetal heart rate is the primary measurement to determine the health of the fetus and full use of modern electronics is made to measure the rate and variability in the rate which occurs in both a healthy and compromised fetus. Real time documentation is also part of the process. At birth the heart rate remains the primary vital sign of the neonate but measurement now relies on auscultation without any real-time documentation, at least until a satisfactory signal from pulse oximetry can be obtained. Pulse oximetry takes at least one minute before the signal is reliable but during this first minute critical decisions regarding care have to be made and during this time critical damage to the neonatal brain can occur if the wrong decision has been made. We describe how this gap in accurate measurement and documentation can be closed.
Early cord clamping has been a common although variable practice at all births throughout Europe for the past 40 years. It is known to result in a variable degree of hypovolemia, reduced cardiac output, reduced cerebral circulation, and an immediate loss of placental oxygenated blood. Hypoxic ischemia of the brain at birth is recognized to be a major underlying cause of cerebral palsy. Using very conservative estimates of the adverse effects of early cord clamping in a proportion of births according to the survey of its use in Europe and an estimate of the cost of care for an individual with cerebral palsy, we have calculated a possible cost for the intervention which is unnecessary and continued practice is largely the result of habit and poor understanding of the physiology of transition.
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