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Domain > www.hutchon.net
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AlienVault OTX
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DNS Resolutions
Date
IP Address
2014-03-08
213.171.219.226
(
ClassC
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2024-09-19
88.208.252.162
(
ClassC
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Port 80
HTTP/1.1 200 OKContent-Type: text/htmlContent-Length: 8655Connection: keep-aliveKeep-Alive: timeout15Server: nginx/1.25.3Date: Thu, 19 Sep 2024 03:11:06 GMTLast-Modified: Sat, 08 Jul 2023 17:48:55 GMTAccept-Ranges: bytesETag: 578f2b77c4b1d91:0X-Powered-By: ASP.NET html> head>title>Cord clamping at birth /title>p stylemso-outline-level:5>b>span stylecolor:black>Cord clamping at birth before closure of the placental citculation is commnon practice around the world. The harm of early cord clamping is never trivial.It is onlyvery rarely necessary either for the mothers safety or for the newborns safety.H2>The problem starts with the basic mis-understanding of the fetal to adult pattern physiology taught around the world./H2> br>How well are We Teaching the Physiology of Transition at Birth?br>br>/H2>A true physiological transition of the circulation at birth does not include any intervention. Teaching texts weresearched and we found that nearly all included the intervention of cord clamping either overtly or covertly. Theimplications of this distortion of physiology are discussed.br>br>H3>Introduction/H3>br>br>Human physiology is primarily about understanding how our bodies function, and armed with this knowledge we should be able to understand how the body responds and adapts to external events.There can be a dispute or uncertainty about the precise way a physiological function works. There can be no dispute that a truephysiological description cannot include any outside intervention. Transition at birth from placental respiration (via the umbilical cordcirculation) into pulmonary respiration is a complex change which has to occur with relative speed. Recent practice has been to assist thistransition by clamping the umbilical cord at birth. However no matter how beneficial or otherwise this may be, this outside interventioncannot be included in a true physiological description.br>H2>Method/H2>br>A range of well-known physiology and medical textbooks stocked in the hospital library were searched for a description of transition of theneonate at birth. The description of transition of the circulation was checked to determine how the closure of the placental circulation wasachieved and whether or not an umbilical cord clamps was included in this description. Eight textbooks were found to contain the descriptionof physiological transition at birth.br>BR>B>U>Results and Discussion/U>/B>br>br>Here is the description in the 24th edition of Ganongs Reviewof Medical Physiology 1. The description was checked to determinewhether or not it met with physiology. Because of thepatent ductus arteriosus and formen ovale, the left heart and rightheart pump in parallel in the fetus rather than in series as they do inthe adult. At birth, the placental circulation is cut off and theperipheral resistance suddenly rises. The pressure in the aorta risesuntil it exceeds that in the pulmonary artery. Meanwhile, because theplacental circulation has been cut off the infant becomes increasinglyasphyxial. Finally, the infant gasps several times, and the lungs expand.The markedly negative intrapleural pressure (-30 to -50 mm Hg)during the gasps contributes to the expansion of the lungs, but otherfactors are likely also involved. The sucking action of the first breathplus constriction of the umbilical vein squeezes as much as 100mL ofblood from the placenta (The placental transfusion).br>BR>Firstly this description does not provide any explanation for thestatement that At birth, the placental circulation is cut off . . . . whichis clearly a sudden event as it results in the peripheral resistancesuddenly rising. The passive tense suggests an outside influence hasled to the placental circulation being cut off. In a normal physiologicaltransition there is no sudden cut off of the placental circulationwhich usually continues for at least 120 seconds 2. Ganongsdescription states that the infant is becoming increasingly asphyxiatedhowever a recent investigation showed a steady rise in the cordarterial pO2 and a similar rise in venous pO2 up to 45 seconds afterbirth 2. The sequence of events may not be fully explained in theGanong description but there is the implication that the sequence is inthe same order as they are described. The description therefore is at thevery least, quite confusing by stating that “constriction of the umbilicalvein squeezes as much as 100mls of blood from the placenta.” whenearlier on we are told that the placental circulation has been cut offHow has it opened up again? Even if it was open how can constrictionof the umbilical vein squeeze blood from the placenta into the baby?The use of a cord clamp is not specified in this description but it isdifficult to find an alternative explanation for the events described. Theobvious explanation for the placental circulation being “suddenly cutoff after birth, is the cord clamp. br>The first invention of the cord clampA midwifery surgical clam was published in the Lancet 111 yearsago by Edward Magennis who specifically advised that his clampshould only be placed on the cord when it has ceased to pulsate 3. Theimplication is that any functional circulation within the cord hasceased naturally before the clamp is applied.br>Two other textbooks of physiology were available and thedescriptions of transition was equally distorted by including anumbilical cord clamp 4,5. Grays Anatomy provides a satisfactorydescription 6 providing a biochemical and physiological explanationfor the construction of the umbilical vessels. Two textbooks ofpaediatrics 7-9, and one of cardiology 10 describes the cord clampas part of the physiological process.br>br>At best these descriptions are confusing to a student. Physiology is asubject taught at the start of the medical education course at a timewhen subtle influences may not be apparent. Could this partly explainthe reluctance of the medical establishment to consider that applying acord clamp is a medical intervention, while not clamping the cord (orat least delaying clamping for several minutes until its function hasappeared to cease), is close to the normal physiological event. Manyclinicians fail to appreciate that early cord clamping is an intervention.Current research in preterm neonates should regard the physiologicalnorm to be delayed cord clamping 11 and the clinical practice ofearly cord clamping permitted only if a benefit for the neonates iseventually shown in the research.BR>Physiological descriptions of transition must reflect a truephysiological process. If cord clamping is considered to be important, adescription of the physiological adaption to the intervention should beclearly explained. 25th edition of Ganong published January 2016provides a true physiological description.br>BR>ReferencesBR>BR>1. Ganong’s Review of Medical Physiology (2012) In: Barrett KE, BarmanSM (eds). Circulation through special regions (24thedtn). McGraw HillMedical, New York.BR>2. Wiberg N, Källén K, Olofsson P (2008) Delayed umbilical cord clampingat birth has eوٴects on arterial and venous blood gases and lactateconcentrations. BJOG 115: 697-703.BR>3. Magennis E (1899) New Inventions. Midwifery Surgical Clamp. НeLancet May 20: 1373.BR>4. Berne RM and Levy MN (1996) Principles of Physiology (2ndedtn).Mosby, St Louis: 349.BR>5. Lindsay DT (1996) Functional Human Anatomy. Mosby, St Louis: 447.BR>6. Standring S (2005) Grays anatomy: Нe anatomical basis of clinicalpractice.(41stedtn) Elsevier Churchill, Livingstone, Edinburgh: 1052.BR>7. Mc Millan JA (1999) Osaki’s Pediatrics (3rdedtn). Lippincott Williamsand Wilkins, Philadelphia: 286.BR>8. Behrman RE, Klieghman RM, Jenson HB (2004) Nelson’s Textbook ofPediatrics (17thedtn) Saunders, Philadelphia: 1479.BR>9. Campbell AGM, McIntosh N (1998) Forfar and Arneil’s Textbook ofPediatrics (5thedtn) Churchill Livingstone New York, Edinburgh:106-107.BR>10. Braunwald E, Zipes DP, Libby P (2001) Heart Disease, A Textbook ofCardiovascular Medicine (6thedtn) Saunders Philadelphia: 1512.11. APTS: Australian Placental Transfusion Study (APTS) ClinicalTrials.govBR>,dentLfier NCT02606Hutchon, Anat Physiol 2016, 6:2DOI: 10.4172/2161-0940.1000e138Editorial Open AccessAnat PhysiolISSN:2161-0940 APCR, an open access journalVolume 6 • Issue 2 • 1000e138Anatomy & Physiology: CurrentnAResearch a ot my & Physiology: Current ResearchISSN: 2161-0940br>br>David J R Hutchon BSc, MB, ChB, FRCOGConsultant Gynaecologist, Memorial Hospital, Darlington, England.br>/body>/html>
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