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The
World Health Organization (WHO) has emphasized in three recent
publications regarding childbirth, various relevant recommendations
on newborn healthcare procedures, including the treatment
of the Umbilical Cord:
- W.H.O:
Care of the Umbilical Cord. A review of the evidence, 1999.
http://www.who.int/rht/documents/MSM98-4/MSM-98-4.htm
- W.H.O:
Recommended practical guidelines in Normal Birth Care, 1999.
http://www.who.int/rht/documents/MSM96-24/msm9624.htm
in particular,
chapters 5.5; 5.6; 6.1; 6.3.
- W.H.O:
ESSENTIAL NEWBORN CARE, Report of the technical Working
Group
(Trieste, 25-29 April 1994): cleanliness, clean delivery
and clean cord care for
prevention and control of nosocomial, newborn and hospital
infections - mother and child: http://www.who.int/rht/documents/MSM9313/essential_newborn_care.htm
(Sizes
of pages mentioned are of A4 paper size).
In two articles; "Care of the Umbilical
Cord. A review of the evidence"
http://www.who.int/rht/documents/MSM98-4/MSM-98-4.htm
and " Recommended practical guidelines in Normal Birth
Care" http://www.who.int/rht/documents/MSM96-24/msm9624.htm
the authors, and the conclusions and recommendations, state
that cutting of the cord should take
place with a sterile disposable instrument, or thoroughly
decontaminated by sterilization. This
is of utmost importance for the prevention of infections.
Although no attendant in practice will admit to the use
of non-sterile devices during childbirth, it may happen
from time to time that in the absence of sterile scissors,
they may use previously used episiotomy scissors.
In "Care of the Umbilical Cord"
Page 12 http://www.who.int/rht/documents/MSM98-4/MSM-98-4.htm
"Timing of cord clamping" end of paragraph: "The
cord should be shielded with a sterile covering to minimize
blood spraying during the procedure." In Page
4, "Importance of cord care"; "In developed
countries, individual cases and epidemics of cord infections
continue to occur, even in supposedly aseptic nurseries
for newborns. Neonatal tetanus and cord infections continue
to be an important
cause of neonatal morbidity and mortality in developing
countries."
In
two articles; "Care of the Umbilical Cord. A review
of the evidence" http://www.who.int/rht/documents/MSM98-4/MSM-98-4.htm
and "Recommended practical guidelines in Normal Birth
Care" http://www.who.int/rht/documents/MSM96-24/msm9624.htm
the authors, and the conclusions and recommendations, state
that early or relatively early clamping
of the cord is mandatory after oxytocin administration is
practiced. The reason for this statement is to avoid
the transfer of different drugs, (administered to the mother
during childbirth), to the newborn via the Umbilical Cord.
The practice of administering drugs to the mother during
childbirth is common in most developed countries. In developing
countries or home childbirth, when
no drugs are used, it is suggested that clamping be delayed,
even until cessation of peristaltic movements in the cord.
In ESSENTIAL NEWBORN CARE, Report of the technical Working
Group, Page 5 http://www.who.int/rht/documents/MSM93-13/essential_newborn_care.htm,
in "The essential newborn care interventions are: 1.
Cleanliness: clean delivery and clean
cord care for the prevention of newborn infections (tetanus
and sepsis)".
In "Care of the Umbilical Cord. A review
of the evidence", page 13 http://www.who.int/rht/documents/MSM98-4/MSM-98-4.htm
in "Length of the cord stump" the authors recommend
clamping the cord 3-4
cm clear of the abdominal wall to avoid pinching the skin
or clamping a portion of the gut which, in very rare instances,
may be inside the cord. As a safety procedure, it
is recommended to leave a stump of at least 4cm when using
Umbicut, the Umbilicus of 4cm is within the range suggested
by WHO.
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