(...There is now considerable evidence that early cord clamping does not benefit mothers or babies and may even be harmful...The situation is a little more complex for babies born by caesarean section or for those who need support soon after birth. Nevertheless, it is these babies who may benefit most from a delay in cord clamping...) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1949472/
Det kanske skulle vara dags att börja titta på detta då, även i Sverige?
Denna har säkert varit med tidigare i tråden, bra att tänka på vid snitt eller en akut situation, om bebisen är medtagen, inte andas och/eller hjärtstopp: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2869%2990213-X/abstract Under inga speciella omständigheter kan bebisen få hela (eller nästan) sin blodvolym på upp till 30 sekunder, förmodligen kortare tid om man mjölkar navelsträngen. Detta förfarandet avviker inte speciellt mycket från de rutiner som används idag i förlossningsvården. Undantaget är att detta gäller bebisar som föds medtagna, inte andas eller med hjärtstopp. Dessa avnavlas idag direkt, men har mycket att tjäna på om man väntar max 30 sekunder. Den extra tiden kan göra en värld av skillnad på hur pass väl bebisen klarar sig, och inte bara överlever.
(...Whether the placental transfusion is effected by gravity or by uterine contraction or by both, it is regulated and terminated reflexively by the child and results in a blood volume that is optimal for survival; those reflexes have been honed to perfection by natural selection over millions of years...) http://www.cordclamp.org/NeonatResusHack.htm
Hur får man sjukvården att förstå vikten av sån här information?
(...The most important factor is the placental transfusion that increases the newborn’s blood volume by 30% to 50%, the additional blood being utilized to activate and establish the functioning of these organ systems. Comprehension of this physiology is essential for elucidating the factors in neonatal depression and in iatrogenic resuscitation that produce the variety of pathology seen in the NICU following incomplete recovery of the depressed newborn...) cordclamp.org
OM dessa väldigt enkla rutiner skulle tillämpas, kanske man skulle slippa att ta till dessa rutiner:
(...The routine procedure for resuscitating an “at risk” or depressed newborn is immediate clamping of the umbilical cord followed by transfer to a warmer where the child’s airway is cleared (by visualization of the vocal cords and tracheal suction in cases of meconium staining) and the baby is stimulated by rubbing the skin. If respiration does not occur within 30 seconds or so, bag-mask ventilation is started; if this fails to produce spontaneous respiration, endo-tracheal intubation is performed with positive pressure ventilation...) cordclamp.org
(...Immediate cord clamping produces the major deviations from “natural resuscitation”; placental oxygenation, placental acidosis regulation, placental glucose supply and placental transfusion are all abruptly aborted and the child is subjected to a period of complete asphyxiation until the lungs function. The warmer deprives the child of the cold crying and cold pressor reflexes. Bag-masking or intubation ventilation readily aerates the alveoli; this reflexively dilates pulmonary arterioles and promotes pulmonary perfusion and the switch from fetal to adult circulation. However, without additional blood volume that is normally supplied by placental transfusion, less than optimal pulmonary perfusion may occur resulting in less than optimal gas exchange and incomplete closure of the foramen ovale and the ductus arteriosus...) cordclamp.org
(...The most common cause of fetal distress in labor is cord compression (cord around the neck, cord prolapse, knot in the cord, oligohydramnios), and measures to relieve cord compression (re-positioning the patient, amnio-infusion, elevation of the presenting part, stopping labor with uterine relaxants) may succeed in returning the fetal heart tracing to normal – may resuscitate the fetus. If these measures do not succeed, the child is born “depressed,” its cord is clamped immediately, and it is transferred to the resuscitation table. Intra-partum cord compression impedes cord venous blood flow (oxygenated, non-acidotic) to the child while allowing cord arterial flow (high pressure) to engorge the placenta. Thus the very “depressed” child (following cord compression) is born in hypovolemic shock, complicated by hypoxia and acidosis – limp and pallid. Immediate cord clamping seals its fate...) cordclamp.org
Ja, vad ska man säga? Om detta stämmer blir det ju "death by hospital"...Fysiologin ovan är på ganska hög kunskapsnivå, är det rätt beskrivet, är det rent ut sagt förbaskat VANSINNIGT att klampa och klippa direkt! Det blir inte så svårt att förstå din frustration (och ilska), Abuelita, som att stånga huvudet i en vägg år ut och år in, för att försöka få sjukvården att uppmärksamma detta, och sedan bli bemött som du blir, speciellt i denna tråden. Sorry for that. Det kräver ju inte ens HLR med intakt navelsträng för sjutton! Bara att man väntar upp till 30 sekunder och/eller mjölkar navelsträngen om det är riktigt bråttom. Hur f*n kan inte modern sjukvård i Sverige FATTA detta?! Vem är ansvarig när det går illa och det med lätthet hade kunnat förhindras? JA, JAG BLIR F*N SKITFÖRBANNAD, när många liv skulle och hade kunnat sparas, och lidande minskas, av 30 sekunders väntan. Det är för sjutton sjukvårdens förbannade plikt och skyldighet att förbättra vården hela tiden, och mycket av den här kunskapen är ju över 30 år gammal! Så VAD exakt är det dom (har) vänta(t)r på...?!
(...The neonate reacts to hypovolemia with massive generalized vaso-constriction that shifts volume circulation from less vital organs to the heart and brain. Depending on the degree of hypovolemia, the clinical signs vary from weakness to those of hypovolemic shock: pallor, hypotension, hypothermia, oliguria / anuria, metabolic acidosis, anemia and respiratory distress syndrome (RDS) otherwise known as “shock lung.” Hypoglycemia caused by deficient liver perfusion has already been mentioned. These signs and symptoms and their related pathology are present to some degree in practically every child admitted to the NICU. They are seldom recognized for what they are, because neonatologists are indoctrinated with the concept that placental transfusion is a pathological event and that an immediately clamped newborn has a normal blood volume. Many neonatologists have never seen a newborn that has closed its cord physiologically...) cordclamp.org
Man vet inte riktigt om man ska skratta eller gråta. Om det stämmer? Jag är inte läkare, det låter rimligt, men ligger lite över min nivå som leg. BMA.
(...There are many consequences of this conceptual error – the insufficient and tardy use of blood volume expanders and blood transfusion in ischemic encephalopathy; the use of medication (vasoconstrictors) to maintain blood pressure in hypovolemic shock while vasoconstriction is causing oliguria and ischemic necrosis of the bowel – necrotizing entero-colitis; the use of surfactant to treat RDS (shock lung) while the hypovolemic shock remains untreated and lungs are under-perfused. All of these and other consequences, and especially those consequences relating to brain damage, [12][21] become irrelevant when the conceptual error is corrected and rational management of neonatal depression is employed...) cordclamp.org
(...Yet, today, every premature child, every compromised child, every newborn “at risk” has its cord clamped immediately in the panicked rush to the resuscitation table. Very, very few die following the procedure, but RDS is a common sequel; many incur neurological impairment [2] and many more remain disabled and dependent on others for the rest of their lives.[1] Growth and development of the brain continues for years after birth, and optimal nutrition and sustenance are required for optimal growth and development. A hiatus in this progress caused by loss of a large amount of blood volume at birth and subsequent anemia may not become apparent for years. [14] [15] The following comment of Windle applies to all immediately clamped newborns:
“A child with a slight brain defect often appears no different from a normal child. His intelligence quotient may lie in the range considered normal, but one never knows how much higher it would have been if his brain had escaped damage in the uterus or during birth.” [12]...) cordclamp.org
