Policies for care during the third stage of labour: a survey of maternity units in Syria

Abstract

BackgroundCare for women during the third stage aims to reduce the risk of major haemorrhage, but is very variable. The current World Health Organisation (WHO) recommendation is that care should include administration of a uterotonic (oxytocin, if it is available) soon after birth of the baby, delayed cord clamping, and delivery of the placenta by controlled cord traction.MethodsTo ascertain care policies used during the third stage of labour in maternity units in Syria, we conducted a survey of 69 maternity units in obstetric and general public hospitals. A brief questionnaire was administered by face to face interview or telephone with senior obstetricians and midwives. Outcome measures were the use of prophylactic uterotonic drugs, timing of cord clamping, use of controlled cord traction, and treatment for postpartum haemorrhage. Obstetricians were asked about both vaginal and caesarean births, midwives only about vaginal births.ResultsResponses were obtained for 66 (96%) hospitals: a midwife and an obstetrician were interviewed in 40; an obstetrician only in 20; a midwife only in 6. Responses were similar, although midwives were more likely to report that the umbilical cord was clamped after 1-3 minutes or after cessation of pulsation (2/40 obstetricians and 9/40 midwives). Responses have therefore been combined.One hospital reported never using a prophylactic uterotonic drug. The uterotonic was Syntometrine® (oxytocin and ergometrine) in two thirds of hospitals; given after delivery of the placenta in 60 (91%) for vaginal births, and in 47 (78%) for caesarean births. Cord clamping was within 20 seconds at 42 hospitals 64%) for vaginal births and 45 (75%) for caesarean births. Controlled cord traction was never used in a quarter (17/66) of hospitals for vaginal births and a half (32/60) for caesarean births.68% of respondents (45/66) thought there was a need for more randomised trials of interventions during the third stage of labour.ConclusionMost maternity units report using Syntometrine®, usually given after delivery of the placenta, clamping the cord within 20 seconds, and using controlled cord traction.

Umbilical cord clamping and management of the third stage of labor: A telephone-survey describing Swedish midwives’ clinical practice

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Integrated review of the knowledge, attitudes, and practices of maternity health care professionals concerning umbilical cord clamping

“…A total of 30 articles were identified that provided description relating to maternity health professionals' knowledge, attitudes, or practice of umbilical cord clamping. Twelve papers were excluded because they did not meet inclusion criteria or the aims of this integrative review 20–31 . One short report of original research findings that provided minimal yet sufficient methodological detail 32 was also included because the study aims and results were directly relevant to this review.…”

“…Twelve papers were excluded because they did not meet inclusion criteria or the aims of this integrative review. 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 One short report of original research findings that provided minimal yet sufficient methodological detail 32 was also included because the study aims and results were directly relevant to this review. Analysis of eligible studies identified four main subject areas through a constant comparison method; an overarching approach in the development of the results in IRs.…”

The BabySaver: Design of a New Device for Neonatal Resuscitation at Birth with Intact Placental Circulation

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