Effects of early versus delayed umbilical cord clamping during antepartum lower segment caesarean section on placental delivery and postoperative haemorrhage: a randomised controlled trial
M Withanathantrige
1
, I M R Goonewardene
1
IntroductionDelayed cord clamping (DCC), an inexpensive method which allows physiological placental transfusion has been described since the 1950s [1,2]. DCC is associated with increased birth weight, (mean difference 101g; 95% CI 45-157), increased new born haemoglobin (mean difference 2.2 g/dl; 95% CI 0.3-4.0 g/dl), increased new born haematocrit >45% (RR 16.2; 95% CI 2-127.4) persisting up to 48 hours, and a reduction of the risk of iron deficiency at three to six months of age (RR 2.7; 95% CI 1.0-6.7) [3]. The requirement of phototherapy for neonatal jaundice is reduced by early cord clamping (RR 0. 62; 95% CI 0.41-0.96) compared to DCC [3]. However DCC is not associated with lower Apgar Scores at 5 minutes, increased admission to special care baby units, respiratory distress, severe jaundice or long term adverse effects [3][4][5][6][7]. DCC is also not associated with increased risk of postpartum haemorrhage, blood transfusion, manual removal of placenta or increased duration of third stage of labour [3,[6][7][8]. DCC improves blood pressure, reduces the need for blood transfusions and the risk of intra-ventricular haemorrhage and necrotizing enterocolitis in preterm infants [9]. Furthermore, DCC maintains oxygenation by sustained placental circulation and is beneficial if spontaneous pulmonary respiration is delayed or impaired [10][11][12][13]. Recently the use of the term 'deferred' cord clamping has been recommended as this suggests a planned policy in contrast to the term 'delayed' cord clamping which may imply that the cord is clamped later than the ideal time [14].Although evidence based guidelines have recommended that DCC should be practiced for all births, in
All the samples were assessed in the microbiology laboratory of the CSTH. Samples were cultured on Cystine Lactose Electrolyte Deficient (CLED) Agar medium and a colony count of more than 10 5 per ml of urine was taken as significant bacteriuria. The antibiotic sensitivity was assessed in accordance with Clinical and Abstract Key Words: Asymptomatic bacteriuria, Pregnancy, Nitrofurantoin Background: Nitrofurantoin has been recommended as a first line therapy in Sri Lanka for urinary tract infections in pregnancy but it is not used frequently
Materials and Methods:At the Colombo South Teaching Hospital a descriptive cross sectional study was carried out from June 2015 to April 2016 on 98 consecutive pregnant women between eight to 24 weeks of gestation, residing in Colombo district and presenting with no urinary symptoms suggestive of urinary tract infection at the time of urine collection but having a positive urine culture (colony count of > 10 5 per ml of urine). The antibiotic sensitivity of the identified pathogens was studied.
Results:The commonest organism found was Coliforms (n = 79) .The other organisms identified were Staphylococci (n = 10), Streptococci (n = 7) and Enterococci (n = 2). All the organisms were sensitive to Nitrofurantoin. However, Nitrofurantoin was used only in 57 women.
Conclusion:As all the organisms were sensitive to Nitrofurantoin, prescribing practices need to be changed to include Nitrofurantoin as the first line of therapy for asymptomatic bacteriuria of pregnancy.
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