Active versus expectant management of third stage of labour

Abstract

Sir—Although the findings of Jane Rogers and co-workers1Rogers J Wood J McCandlish R Ayers S Truesdale A Elbourne D Active versus expectant management of third stage of labour: the Hinchinbrooke randomised controlled trial.Lancet. 1998; 351: 693-699Summary Full Text Full Text PDF PubMed Scopus (171) Google Scholar have potentially important public-health implications, we urge caution with regard to an approach that involves application of drugs to promote contractions, early clamping and cutting of the umbilical cord (rather than waiting to clamp until the cord stops pulsating), and application of tension to the umbilical cord.In a randomised trial in Guatemala,2Grajeda R Pérez-Escamilla R Dewey KG Delayed clamping of the umbilical cord improves hematological status of Guatemalan infants at 2 months of age.Am J Clin Nutr. 1997; 65: 425-431PubMed Google Scholar we showed that waiting to clamp the umbilical cord at the level of the placenta until it stopped pulsating reduced by half the rate of infant anaemia at age 2 months (88% vs 42%, immediate vs delayed clamping). Studies conducted in developed countries have also documented improved infant haematological outcomes as a result of delayed clamping.3DeMarsh QB Windle WF Alt HL Blood volume of newborn infants in relation to early and late clamping of umbilical cord.Am J Dis Child. 1942; 53: 1123-1129Google ScholarRogers and colleagues acknowledge that their active-management procedures may have adverse effects on haematological outcome in children, and we are reassured that they apparently plan to follow-up the children to investigate this effect. Their study, however, does not explain which component(s) of their experimental management is (are) responsible for the protective effects against maternal bleeding that they observed. Because there are few cost-effective interventions for the prevention of anaemia during early infancy, it is important that health agencies and medical schools do not promote rapid clamping of the umbilical cord. A change in this recommendation would be warranted only if there is evidence that rapid cord clamping is beneficial to the mother and that this outweighs the risks to the infant. Sir—Although the findings of Jane Rogers and co-workers1Rogers J Wood J McCandlish R Ayers S Truesdale A Elbourne D Active versus expectant management of third stage of labour: the Hinchinbrooke randomised controlled trial.Lancet. 1998; 351: 693-699Summary Full Text Full Text PDF PubMed Scopus (171) Google Scholar have potentially important public-health implications, we urge caution with regard to an approach that involves application of drugs to promote contractions, early clamping and cutting of the umbilical cord (rather than waiting to clamp until the cord stops pulsating), and application of tension to the umbilical cord. In a randomised trial in Guatemala,2Grajeda R Pérez-Escamilla R Dewey KG Delayed clamping of the umbilical cord improves hematological status of Guatemalan infants at 2 months of age.Am J Clin Nutr. 1997; 65: 425-431PubMed Google Scholar we showed that waiting to clamp the umbilical cord at the level of the placenta until it stopped pulsating reduced by half the rate of infant anaemia at age 2 months (88% vs 42%, immediate vs delayed clamping). Studies conducted in developed countries have also documented improved infant haematological outcomes as a result of delayed clamping.3DeMarsh QB Windle WF Alt HL Blood volume of newborn infants in relation to early and late clamping of umbilical cord.Am J Dis Child. 1942; 53: 1123-1129Google Scholar Rogers and colleagues acknowledge that their active-management procedures may have adverse effects on haematological outcome in children, and we are reassured that they apparently plan to follow-up the children to investigate this effect. Their study, however, does not explain which component(s) of their experimental management is (are) responsible for the protective effects against maternal bleeding that they observed. Because there are few cost-effective interventions for the prevention of anaemia during early infancy, it is important that health agencies and medical schools do not promote rapid clamping of the umbilical cord. A change in this recommendation would be warranted only if there is evidence that rapid cord clamping is beneficial to the mother and that this outweighs the risks to the infant. Active versus expectant management of third stage of labourAuthors' reply Full-Text PDF