Early Versus Delayed Umbilical Cord Clamping on Physiologic Anemia of the Term Newborn Infant

AIM: Our study aims to make a comparison between the effects of milking of umbilical cord versus delayed cord clamping on Hemoglobin level at 6 weeks from delivery among term neonates and which method is more beneficial for them.DESIGN: It was a randomised control study. Participants were randomised into 2 groups; Group 1: 125 women were assigned to delay cord clamping; Group 2: 125 women were assigned to milking of the umbilical cord 5 times before cutting. Student t-test was used to compare between the two groups for quantitative data, for qualitative data chi-square test and the Correlation coefficient was done to test the association between variables.SETTING: This study was at El-Galaa Teaching Hospital, labour suite. Cairo, Egypt.PARTICIPANTS: A group of 250 pregnant women starting from ≥ 37 weeks’ gestational age.INTERVENTION: In this study, we searched if the mechanism of milking or delayed cord clamping could give some of the positive benefits for neonates or not.RESULTS: In this study, we found that milking of the umbilical cord five times as in group 1 was associated with higher hemoglobin levels at 6 weeks after birth, at physiological anemia of the fetus and significant but clinically there was no difference between the two groups (10.4 ± 0.5 and 10.6 ± 0.5 respectively, P < 0.001). Also, there was a positive correlation between haemoglobin of the mother and the newborn during the first day and after 6 weeks with r = 0.349 and 0.283 respectively and a P value < 0.001. Furthermore, there was a positive correlation between the haemoglobin of the fetus after the first day and fetus at 6 weeks with r = 0.534 and a P value < 0.001. For most other outcomes (including APGAR score, positive pressure ventilation, poor neonatal outcomes such as respiratory distress syndrome there were no significant differences between the two groups. Our study may recommend the use of umbilical cord milking in term babies when delayed cord clamping is unavailable.CONCLUSION: Umbilical cord blood milking after its clamping improves some important haematological parameters for newborns, especially in countries with high incidence of anaemia in newborns and children.

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Communication is an innately fascinating and, on occasions, a somewhat mysterious topic. At its heart, it is the means of expressing, both to ourselves and to others, how we perceive the world and how we influence the world around us. It is a tool for exchanging information and meaning, but also a way to connect with others. While obviously a means to an end, it is also an end in itself—without the ability to share with others, life would be greatly impoverished. The many human dimensions of communication— the practical, the social, the linguistic, the lyrical, the subliminal, its ability to soothe and to injure, to inform, to entertain, to terrify—are what make this topic so challenging. Anaesthesia has come a very long way since the 1840s. The advent of safer and more selective drugs, coupled with ever more sophisticated technology, has made the practice of anaesthesia safer, yet also more complicated. The patients that we treat are often older, have multiple co-morbidities, and are undergoing procedures that would have been unthinkable 20 years ago. Yet with the increasingly complex workload have come the additional pressures of time and resource allocation. Patients are admitted on the day of surgery, leaving minimal time for anaesthetic assessment. Anaesthetists are frequently busy, isolated and unavailable when working in theatre, or find themselves working at multiple sites with little opportunity for interaction with colleagues. Similarly, theatre staff rarely work in the same operating room with the same team on a regular basis. The hospital administrators are under constant pressure as they strain to contain costs and reduce length of stay, while wards are increasingly understaffed and overworked. In the midst of all this, patients are left wondering who is actually caring for them, and if anyone is listening to their concerns. Anaesthetists play a crucial role in multi-professional teams in a wide variety of clinical settings of which theatre is only one. There is the high dependency unit (HDU), the labour suite, paediatrics, the chronic pain clinic—to name but a few. In almost every aspect of anaesthetic clinical practice the ability to communicate effectively is a vital component of patient care.

Analgesic Efficacy of Pfannenstiel Incision Infiltration with Ropivacaine 7.5 mg/mL for Caesarean Section

Background. Pain after Caesarean delivery is partly related to Pfannenstiel incision, which can be infiltrated with local anaesthetic solutions.Methods. A double- blind randomized control trial was designed to assess the analgesic efficacy of 7.5 mg/mL ropivacaine solution compared to control group, in two groups of one hundred and forty four parturients for each group, who underwent Caesarean section under spinal anaesthesia: group R (ropivacaine group) and group C (control group). All parturients also received spinal sufentanil (2.5 g).Results. Ropivacaine infiltration in the Pfannenstiel incision for Caesarean delivery before wound closure leads to a reduction of 30% in the overall consumption of analgesics (348 550 mg for group R versus 504 426 mg for group C with ), especially opioids in the first 24 hours, but also significantly increases the time interval until the first request for an analgesic (4 h 20 min 2 h 26 for group R versus 2 h 42 1 h 30 for group C). ThePvalues for the two groups were: for paracetamol, for ketoprofen andPfor nalbuphine which was the most significant. There is no significant difference in the threshold of VAS in the two series.Conclusion. This technique can contribute towards a programme of early rehabilitation in sectioned mothers, with earlier discharge from the post-labour suite.