Health ministry Advisory for oxytocin during childbirth
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A latest bewildering advisory by the Health ministry sent to health officials in all states and Union Territories calls on obstetric staff to delay giving the drug called oxytocin until after the uterus has expelled the placenta(which could take five to 10 minutes after the baby’s birth), which is in complete contrast from the standard protocol of giving oxytocin to all women within a minute of her baby’s birth as recommended by the World Health Organisation (WHO) and other obstetrics associations. Oxytocin, a potentially life-saving medicine to women after natural childbirth, helps reduce post-partum bleeding, which is the leading cause of maternal deaths in India and other countries.

Several senior obstetricians and maternal health experts have pointed out that the advisory deviates from the standard protocol as recommended by the World Health Organisation (WHO). The advisory primarily advocates delayed cord clamping (DCC) — clamping and cutting of the umbilical cord to separate the baby from the placenta one to three minutes after birth — recommended by the WHO since October 2006 and practised in many countries, including India.

Multiple studies have established that DCC yields major benefits to the newborn, including lower rates of anaemia, sepsis and devastating intestinal inflammation.

The advisory sent to health mission directors across India has cited a study conducted in Dharampur, Gujarat, and Calcutta in 2018 and has described its recommendations as part of “best practices”. Senior neonatologist Arun Singh, who led the study, said the philosophy underlying the study and advisory sought to recognise childbirth as a natural physiological process and pull away from the current “overmedicated” approaches.

According to the study authors Natural oxytocin, which the mother herself produces, is far superior to artificially injected oxytocin. Naturally produced oxytocin allows the upper part of the uterus to contract and facilitate natural expulsion of the placenta — most women do not need artificial oxytocin injections.

Their study, published in May this year in the American Journal of Perinatology, reported that DCC babies had better oxygen saturation than babies managed through early cord clamping.

Singh said the protocol that the study assessed had been adopted across Gujarat and over 1,000 women had given birth. “We have absolutely no adverse reports,” he said.
Both Singh and another study team member, Manoj Das, a child and public health expert in New Delhi, have claimed that several studies have shown that women do fine even when they do not receive oxytocin within one minute.

“Immediate oxytocin after birth has been proven as effective in reducing the risk of post-partum haemorrhage over and over again in many countries over many years,” Ozge Tuncalp, a physician-epidemiologist at the WHO’s department of reproductive health and research in Geneva.

The injected oxytocin induces contractions of the uterine muscles allowing the placenta to shear off the wall of the uterus while closing the blood vessels that open up as the placenta separates. This lowers the risk of bleeding.
The advisory has triggered surprised exchanges in various medical groups.

Source: https://www.telegraphindia.com/health/baffling-advisory-on-childbirth-medicine/cid/1718847?ref=health_health-page
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Dr. G●●●●●k S and 30 others like this28 shares
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Dr. N●●●●a G●●●a
Dr. N●●●●a G●●●a Obstetrics and Gynaecology
We need to have larger data to support the study. The delay will decrease the incidence of retained placenta and will be beneficial for the baby too in terms of Hb, but in India where aneamia is a major issue this guidline is to be accepted with a pinch of salt.
Nov 16, 2019Like
Dr. V●●●●●●j D●●●i
Dr. V●●●●●●j D●●●i Legal Medicine
The advisory/instruction is highly debatable; there can be arguments for and against it, and that too with equal genuine vehemence (not artificially created) on either side.
Nov 24, 2019Like
Dr. V●●●●●●j D●●●i
Dr. V●●●●●●j D●●●i Legal Medicine
The advisory favours neonatal practice by reducing neonatal anemia to a certain extent may be; but oxytocin immediately after delivery definitely favours obstetric practice by reducing need for manual removal of placenta.
Nov 24, 2019Like