W.H.O RECOMMENDATION - TREATMENT OF THE UMBILICAL CORD IN CHILDBIRTH

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:

  1. 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


  2. 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.


  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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