Cord Traction Versus Manual Removal for Placental Delivery during Cesarean Section

2020 ◽  
Vol 103 (9) ◽  
pp. 850-855
Keyword(s):  
Cesarean Section ◽  
Pregnant Women ◽  
Umbilical Cord ◽  
Current Knowledge ◽  
Skills Training ◽  
Major Surgery ◽  
Manual Removal ◽  
The Third ◽  
Third Stage Of Labor ◽  
Third Stage

Background: Cesarean section is the most common major surgery performed on pregnant women around the world. It is necessary to apply the practical skills training and current knowledge, especially in the procedure that would need to help keep mothers alive and the fetus safe. Objective: To study the efficacy of the umbilical cord traction versus manual removal for placenta delivery in the third stage of labor during the cesarean section. Materials and Methods: The present study was a retrospective comparative study conducted in Srisangwornsukhothai Hospital between January 2017 and January 2020. The purposive sample size was calculated by using a power of 80%, with a significant level of 5%. One hundred twenty pregnant women were divided into two groups, sixty pregnant women each, the cord traction as the first group and the manual removal as the second group for placental delivery during the cesarean section. The significance of the two groups were compared by using the independent t-test (p<0.05), 95% confidence interval (CI), and the Mann-Whitney U test. Results: Several outcomes of the umbilical cord traction were better than the manual removal, such as decrease time of the operation and a statistically significant decrease in hemoglobin (p<0.001, 0.049, respectively). However, there was not a statistically significant decrease of blood loss, fever after surgery, or the length of stays (p=0.839, 0.056, 0.175, respectively). Only one outcome, the time of the third stage of labor, was slightly more than the manual removal group for placental delivery during the cesarean section with statistically significance (p=0.003). Conclusion: The umbilical cord traction maneuver for the delivery of the placenta had more advantages than the manual removal maneuver. This technique should be a recommendation during the cesarean section. Keywords: Cesarean section, Umbilical cord traction, Placental delivery

scholarly journals On the history of management of the third stage of labor in Kazan (to the 155th anniversary of the birth of Professor V.S. Gruzdev)

2021 ◽  
Vol 102 (2) ◽  
pp. 249-257
Author(s):  
L A Kozlov
Keyword(s):  
High Efficiency ◽  
Historical Study ◽  
Manual Removal ◽  
The Third ◽  
Obstetrics And Gynaecology ◽  
Third Stage Of Labor ◽  
Third Stage ◽  
Primary Literature ◽  
History Of ◽  
Speed Up

The article aims to show the experience of the Kazan Obstetrics and Gynaecology Clinic named after V.S. Gruzdev for replacing the obstetric operation manual removal of the placenta with other techniques to prevent serious postpartum complications. Research methods the historical study of primary literature sources. Manual removal of the placenta always associated with the risk of infection and developing puerperal sepsis. That is why obstetricians are constantly looking for a replacement for this operation. In 1895, even in the pre-Kazan period of work, professor Gruzdev successfully performed a method of inserting saline into the umbilical vessels to speed-up placental separation in the third stage of labor. While working in Kazan, on his proposal, doctor L.S. Sidorova (1936), and then Professor P.V. Manenkov (1942, 1948, 1955) and doctor M.V. Korotkova (1958) thoroughly studied and implemented the method of Budimilich in the work of the maternity ward of the clinic. This method involves replacing the saline solution with the crude alum solution. The second measure, preventing hemorrhage in the third stage of labor and avoiding manual removal of the placenta, was the successfully testing intravenous pituitrin (oxytocin) injection by Z.N. Yakubova, completed with the defense of her doctoral dissertation (1962). The high efficiency of these methods allowed us to recommend to them for widespread obstetric practice.

scholarly journals Manual Removal of the Placenta after Vaginal Delivery: An Unsolved Problem in Obstetrics

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Fiona Urner ◽  
Roland Zimmermann ◽  
Alexander Krafft
Keyword(s):  
Maternal Morbidity ◽  
Placenta Previa ◽  
Morbidity And Mortality ◽  
Active Management ◽  
Retained Placenta ◽  
Manual Removal ◽  
The Third ◽  
Third Stage Of Labor ◽  
Third Stage ◽  
Maternal Morbidity And Mortality

The third stage of labor is associated with considerable maternal morbidity and mortality. The major complication is postpartum hemorrhage (PPH), which is the leading cause of maternal morbidity and mortality worldwide. Whereas in the event of PPH due to atony of the uterus there exist numerous treatment guidelines; for the management of retained placenta the general consensus is more difficult to establish. Active management of the third stage of labour is generally accepted as standard of care as already its duration is contributing to the risk of PPH. Despite scant evidence it is commonly advised that if the placenta has not been expelled 30 minutes after delivery, manual removal of the placenta should be carried out under anaesthesia. Pathologic adhesion of the placenta in the low risk situation usually is diagnosed at the time of delivery; therefore a pre- or intrapartum screening opportunity for placenta accreta would be desirable. But diagnosis of abnormalities of placentation other than placenta previa remains a challenge. Nevertheless the use of ultrasound and doppler sonography might be helpful in the third stage of labor. An improvement might be the implementation of standardized operating procedures for retained placenta which could contribute to a reduction of maternal morbidity.

scholarly journals Natural and Synthetic Oxytocin—Structurally Same but Differ in Effects—A Pilot Study

2021 ◽  
Author(s):  
Katarzyna Wszołek ◽  
Karolina Chmaj-Wierzchowska ◽  
Małgorzata Pięt ◽  
Agata Tarka ◽  
Maciej Wilczak
Keyword(s):  
Umbilical Cord ◽  
Labor Induction ◽  
Active Management ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
The Third ◽  
Third Stage Of Labor ◽  
Third Stage ◽  
Synthetic Oxytocin ◽  
Umbilical Cord Vein

Abstract Purpose: synthetic oxytocin is currently used to induce labor and strengthen the contractile function in the first or second stage of labor. It is also used therapeutically and prophylactically in the third stage of labor. We aimed to correlate the dose and duration of synthetic oxytocin infusions used during induction of labor, augmentation of labor in the first and second stage of labor, and during active management of labor in the third stage of labor to the level of prolactin and cortisol in the serum of the parturient blood and from the umbilical cord vein.Methods: The mother’s blood was collected from a venous vessel and foetal from the umbilical cord vein just cutting was performed and the levels of cortisol and prolactin was evaluated by electrochemiluminescence (ECLIA). The blood sample from the umbilical cord vein and artery were collected to separate heparinized capillaries and the pH, base deficit (BD), pO2, and CO2 concentration were assessed.Results: We observed decreased level of prolactin immediately after the labor depending on the total dose of synthetic oxytocin used. We did not observe any relationship between the level of prolactin on postpartum day 2 on the dose of administered hormone or the fact of the labor induction. We observed significant correlations with regard to hormone levels without the synthetic oxytocin total dosage correlation. Conclusion: We strongly believe that the definition of uniform norms and principles with regard to the dosage of synthetic oxytocin for labor induction should be determined.

Is epidural analgesia during labor related to retained placenta?

2016 ◽  
Vol 44 (4) ◽  
Author(s):  
Avraham Sarit ◽  
Amit Sokolov ◽  
Ariel Many
Keyword(s):  
Logistic Regression ◽  
Cesarean Section ◽  
Epidural Analgesia ◽  
Older Age ◽  
Previous Cesarean Section ◽  
Retained Placenta ◽  
The Third ◽  
Third Stage Of Labor ◽  
Third Stage ◽  
Previous Cesarean

AbstractTo explore the influence of epidural analgesia on the course of the third stage of labor and on the incidence of the complete retained placenta as well as retained parts of the placenta.This is a population-based cohort study in a tertiary medical center. We collected data from all 4227 spontaneous singleton vaginal deliveries during 6 months and compared the incidence of retained placenta in deliveries with epidural analgesia with those without analgesia. Multivariable logistic regression was used to control for possible confounders.More than two-thirds of the women (69.25%) used epidural analgesia during their delivery. A need for intervention due to placental disorder during the third stage of labor was noted in 4.2% of all deliveries. Epidural analgesia appeared to be significantly (P=0.028) related to placental disorders compared with no analgesia: 4.8% vs. 3%, respectively. Deliveries with manual interventions during the third stage, for either complete retained placenta or suspected retained parts of the placenta, were associated with the use of epidural analgesia (P=0.008), oxytocin (P=0.002) and older age at delivery (P=0.000), but when including all factors in a multivariable analysis, using a stepwise logistic regression, the factors that were independently associated with interventions for placental disruption during the third stage of delivery were previous cesarean section, oxytocin use and, marginally, older age.Complete retained placenta and retained parts of the placenta share the same risk factors. Epidural analgesia does not directly influence the incidence of complete retained placenta or retained parts, though clinically linked through increased oxytocin use. The factors that were independently associated with interventions for placental disruption during the third stage of delivery were previous cesarean section, oxytocin use and older age.

scholarly journals Delayed Cord Clamping in Term Neonates: Attitudes and Practices of Midwives in Irish Hospitals

2018 ◽  
Vol 8 (1) ◽  
pp. 4-17 ◽  
Author(s):  
Joan Devin ◽  
Patricia Larkin
Keyword(s):  
Umbilical Cord ◽  
Active Management ◽  
Delayed Cord Clamping ◽  
Term Neonates ◽  
The Third ◽  
Cord Clamping ◽  
Third Stage Of Labor ◽  
Maternity Hospitals ◽  
Third Stage ◽  
Early Cord Clamping

Background:At the time of birth, the baby is attached to its mother’s placenta via the umbilical cord. A delay in cord clamping is physiologically beneficial to the neonate as they receive an increase in blood volume (30%–40%), increased iron stores (20–30mg/kg), and an easier transition to extrauterine life. Active management of the third stage of labor, in order to prevent maternal postpartum hemorrhage, may contribute to early cord clamping practices in Ireland. Objective:To describe the current practices and attitudes of midwives in Irish hospitals toward delayed cord clamping in term neonates. Methods:A cross-sectional descriptive survey was distributed to three maternity hospitals and two Irish online midwifery groups. Results:One hundred and fifty-three valid responses were received. One hundred and eleven midwives (72.4%) defined delayed cord clamping as “clamping after the cord ceases to pulsate.” One hundred and forty (91.5%) respondents practiced delayed cord clamping. Moreover, 62.7 % (98/153) of participants routinely clamp the umbilical cord >1 minute when practicing active management of the third stage, with 49.1% (48/98) of those waiting until cord pulsations have ceased. Awareness of research, practice guidelines advising delayed cord clamping, and experience of practicing physiological third stage are associated with increased delayed cord clamping practices. Early cord clamping is influenced by a deteriorating neonatal or maternal condition and the cultural context within clinical sites. Delayed cord clamping times during active management of the third stage differ significantly between clinical sites and maternity care pathways.Conclusion:A variety of midwifery practices were identified with differing attitudes toward cord clamping practices. Diverse influences included the practice environment, awareness of research, and availability of adjunct resuscitation supports. Recommendations for future practice include a synchronized approach to delayed cord clamping in the third stage of labor, including the provision of a national guideline.

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