evidence based, safe and effective care
As stated earlier, NICE (2014) claims that PPH is a risk of physiological third stage. Therefore, this guideline encourages midwives to advise women to have active management of the third stage because they claim that it is associated with a lower risk of a PPH and/or bloodtransfusion. Begley et al. (2010) also report that based on five randomised control trials, the active management reduces the risk of major haemorrhage (blood lost over 1000 ml) compare to the physiological third stage. However, Dixon et al. (2013) question the reliability of this finding. They argue that Begley et al. (2010) included randomised controlled trials (RCTs) with participants who received interventions during show more content
She carried out a risk assessment to identify prelabour risk factors of PPH described by Cathy et al. (2013), such as previous retained placenta, previous caesarean section, placenta praevia, accrete or percreta, antepartum haemorrhage, pre-eclampsia, BMI over 35, increased maternal age, uterine abnormalities, maternal haemoglobin below 9g/dL, grand multiparity. Lauras risk assessment did not highlight any prelabour risk factor, therefore she was not considered to be a high risk of show more content
(2013) maintain that the timing of the cords clamping makes no difference to PPH rates, the benefits of delayed cord clamping in the neonates are mentioned in multiple literature. Airey et al. (2008) suggest that delayed cord clamping increases placental transfusion to the baby by 20 percent. This means Lauras baby received approximately 30-90 ml blood and 60-120 mg iron. This can lead to increased tissue oxygenation within the first week of her life, increased haematocrit, haemoglobin and blood volume. These could help to improve Lauras babys resistance to infection and aid neurodevelopment in her infancy.
McDonald et al. (2013) claim that that delayed cord clamping leads to over transfusing red blood cells and it predisposes the baby to jaundice requiring treatment with phototherapy. Airey et al. (2008) agree that babies are higher risk of jaundice, however they question whether there is an increased requirement to treat
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