
David HutchonSheffield Hallam University | SHU · Materials and Engineering Research Institute (MERI)
David Hutchon
BSC, MB, CH.B, FRCOG
About
117
Publications
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Introduction
During pregnancy, ultrasound doppler is used to determine the heart rate of the fetus (unborn baby). This has been established practice throughout the world for over 40 years. It is accurate and audible, which means that anyone in the room can immediately hear if there is a problem with the fetal heart rate. After birth the heart rate of the new born baby is traditionally detected using a stethoscope over the baby’s chest. This is an inferior technique in that it is only heard by one person.
Education
September 1964 - June 1970
Publications
Publications (117)
There is a need for improved measurement and documentation of the neonatal heart rate immediately after birth, which currently relies on auscultation with a stethoscope. Measurement of the heart rate is a medical requirement within the first minute after birth in all babies. Heart rate at birth is the only reliable indicator of the health of the ne...
Determining the neonatal heart rate immediately after birth is unsatisfactory. Auscultation is inaccurate and provides no documented results. The use of foetal Doppler ultrasound has been recognised as a possible method of determining the neonatal heart rate after birth over the last nine years. This review includes all published studies of this ap...
Immediate clamping and cutting of the umbilical cord have been associated with death and/or neurodisability [1–5]. Given the harm from immediate cord clamping it would seem logical that all infants should receive delayed cord clamping, but evidence for delayed cord clamping when resuscitation is required is limited. One approach would be to perform...
Background
Recent studies suggest that delayed cord clamping (DCC) is advantageous for achieving hemodynamic stability and improving oxygenation compared to the immediate cord clamping (ICC) during fetal-to-neonatal transition yet there is no quantitative information on hemodynamics and respiration, particularly for pre-term babies and fetal diseas...
Delayed cord clamping, the common term used to denote placental-to-newborn transfusion at birth, is a practice now endorsed by the major governing bodies affiliated with maternal-newborn care. Despite considerable evidence, delayed cord clamping, not early cord clamping, continues to be viewed as the “experimental” intervention category when discus...
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The Resuscitation Council (UK) explains the pathophysiology of acute perinatal hypoxia. They explain that " If subjected to sufficient hypoxia in utero, or during passage through the birth canal, the fetus will attempt to breathe. If the hypoxic insult is continued the fetus will eventually lose consciousness. Shortly after this the neural centers...
The transfer or haemorrhage of a small amount of fetal blood into the mother's circulation throughout most of pregnancy is common. Larger haemorrhage can sometimes be detected immediately post-partum having occurred during the third stage of labour. It is likely that early cord clamping can sometimes be the cause of a massive fetal maternal haemorr...
The rationale for keeping the mother and her newborn together even when neonatal resuscitation is required is presented. The development of a customised mobile resuscitation trolley is detailed explaining how the resuscitation team can be provided with all the facilities of a standard resuscitation trolley to resuscitate the neonate at the mother's...
The heart rate of a neonate at birth is used to determine whether or not resuscitation is required. The normal healthy range of heart rate is not well established and the method for determining the heart rate is often unreliable and undocumented in the first minute or so after birth. The reasons for the poorly established heart rate norms are discu...
A true physiological transition of the circulation at birth does not include any intervention. Teaching texts were searched and we found that nearly all included the intervention of cord clamping either overtly or covertly. The implications of this distortion of physiology are discussed.
Delayed umbilical cord clamping (DCC) permits placental-to-newborn transfusion and results in an increased neonatal blood volume at birth. Despite endorsement by numerous medical governing bodies, DCC in preterm newborns has been slow to be adopted into practice. The purpose of this article is to provide a framework to guide medical providers inter...
A paper which shows how the majority of physiology textbooks are not describing true physiology.
The increased need for phototherapy for non-haemolytic hyperbilirubinaemia is frequently
given as a barrier to the introduction of routine delayed cord clamping. However the
evidence for this increased need is not consistent. At one end of the scale there is one
subset of the McDonald (1996) study [1] combined with the Oxford Midwives (1991) [2]
sh...
Evidence is growing on the potential value of enhancing placental-fetal transfusion at birth, with recent endorsement of the practice by the World Health Organization and American College of Gynecologists. However, these recommendations provide clinicians with little guidance on the optimal practice among infants born extremely premature (<28 weeks...
Early cord clamping has been a common although variable practice at all births throughout Europe for the past 40 years. It is known to result in a variable degree of hypovolemia, reduced cardiac output, reduced cerebral circulation, and an immediate loss of placental oxygenated blood.
Hypoxic ischemia of the brain at birth is recognized to be a maj...
Early cord clamping was initially introduced as part of the package of care known as “active management of the third stage”, which was implemented to reduce postpartum hemorrhage. It has now been shown to provide no benefit to the mother and to result in harm to the neonate. The clinical trial evidence relating to delayed cord clamping compared to...
Physiolgical transition ?
David JR Hutchon, Emeritus Consultant Obstetrician
Darlington Memorial Hospital
Dear Sir,
We congratulate the authors on this study of neonatal transitional circulation performed so quickly after birth. The authors state that the ductal flow ratio reported in their study reflects pulmonary and haemodynamic transition...
Objective:
To investigate the effects of interventions promoting placental transfusion at delivery (delayed cord clamping or umbilical cord milking) compared with early cord clamping on outcomes among premature neonates of less than 32 weeks of gestation.
Data sources:
A systematic search was conducted of PubMed, Embase, and ClinicalTrials.gov d...
I n recent times, the idea of initiating resuscitation before clamping the umbilical cord has often been disregarded and considered unimportant. Artistotle had described resuscitation of the neonate by milking the intact cord 1. Then, in the 15th century, there was one of the first documentations of neonatal resuscitation by initiating ventilation...
Third stage practice, including the timing of cord clamping and its impact on neonatal health, has been comprehensively reviewed previously by Downey and Bewley, and this opinion will focus on the evidence about neonatal transition which has been published since. Many professional organisations and experts recommend at least a 30-second delay befor...
Hemodynamics of the fetal to neonatal transition are orchestrated through complex physiological changes and results in cardiovascular adaptation to the adult biventricular circulation. Clinical practice during this critical period can influence vital organ physiology for normal newborns, premature babies and congenital heart defect patients. Partic...
During labour the fetal heart rate is the primary measurement to determine the health of the fetus and full use of modern electronics is made to measure the rate and variability in the rate which occurs in both a healthy and compromised fetus. Real time documentation is also part of the process. At birth the heart rate remains the primary vital sig...
S ixty delegates from the USA, Australia, Sweden, France, Ireland and the UK gathered at the University of Birmingham on 19 April 2013 to attend the first conference to address the topic of transitional care at birth, organised by Dr David Hutchon. The conference explored in detail our current understanding of physiological transition at birth. Tex...
Although nuchal cord is a common occurrence at birth, there is little attention to its importance or management at birth, and teaching includes premature clamping and cutting of the cord as the common option. Although grade 1 evidence is lacking, the optimal management of the nuchal cord, the Somersault manoeuvre is not taught or included in any cu...
Over the past 40 years, there have been a number of review articles attempting to rationalise cord clamping practice. Early cord clamping was originally thought to be important in active management of the third stage of labour, but this was never evidence based. Without an evidence base to justify it, early cord clamping in clinical practice has re...
Rennie andRosenbloom1 have included a review of the effect
of hypoxia and ischaemia on the neonatal brain from animal
studies. It is interesting to note that sometimes only hypoxia is
mentioned and at other times it is a combination of hypoxia
and ischaemia. While they frequently go together there are
distinctions, in that hypoxia is possiblewithou...
In 2007 an editorial by Andrew Weeks advised that it was better for the baby not to rush to clamp and cut the cord at birth ( BMJ 2007;335:312, doi:10.1136/bmj.39282.440787.80). He believed that it was time for us to follow the World Health Organization and the International Federation of Gynecology and Obstetrics and that other guidelines should r...
Summary Desmopressin is a synthetic analogue of vasopressin with a prolonged antidiuretic effect; 20 μg were given intranasally to 7 normal healthy volunteers and to 80 pregnant women to assess its safety and efficacy in pregnancy as a test of renal concentrating ability. There were 27 normal pregnancies, 18 with hypertension and 35 with bacteriuri...
There is no consensus amongst medical and midwifery staff on the optimum time to cut the umbilical cord following childbirth. Studies have shown that delaying cord clamping for at least 30 seconds is associated with less need for blood transfusion and respiratory support. In 2004, Rabe et al. recommended delayed cord clamping for up to 120 seconds...
There is good evidence that immediate cord clamping can harm the newborn baby.
Delaying cord clamping for at least 30 seconds is possible in all deliveries.
Learning objectives: To increase awareness of the need for routine delayed clamping by obstetricians and midwives.
To explore the practice in the presence of fetal distress and nuchal cord.
E...
Background. Delayed cord clamping of at least 30 seconds is a Cochrane recommendation for preterm births. Term babies. especially those delivered by caesarean section and those with a nuchal cord also benefit from delayed clamping at birth. Although the delay in resuscitation is not thought to cause damage and, overall, the delay benefits the baby....
Delayed cord clamping and objections Sir, Dr Kent provides an excellent overview of the issue of delayed cord clamping in his Snippets. As he explains, there is no basis for the many objections sometimes put forward. Two other objections which he did not mention are the risk of hypother-mia and the need for a valid cord pH. Hypothermia is a serious...
As well as seeming to discourage the detection of postpartum depression,1 the National Institute for Health and Clinical Excellence (NICE) is also encouraging the artificial intervention of immediate cord clamping.2The NICE guideline for caesarean section includes a section on cord clamping. It states a number of “suggested” benefits and a number o...
Preterm birth remains a major cause of perinatal mortality and morbidity. The outcome of preterm birth is dependent on multiple factors in the management of the pregnancy, delivery and neonatal care. Each element of care may be critical to the outcome especially at the threshold of gestation survival. The CESDI 27/28 week report audited many of the...
A modified design of loop knot that provides a secure knot when tied in Vicryl® is described. Initial tests indicate that the knot has characteristics superior to other knots tied in this suture material.
Objective
To describe a new design of knot pusher which allows secure locking of some extracorporeal slip knots during a single pass.DesignDescription of the instrument and its use with review of the literature.Conclusion
This instrument provides an effective method of making secure slip knots in laparoscopic surgery.
Re: Trisomy 21: 91% detection rate using second‐trimester ultrasound markers
D. J. R. Hutchon, Memorial Hospital, Hollyhurst Road, Darlington, County Durham DL3 6HX, UK
Author's reply : G. R. DeVore, Fetal Diagnostic Center, Suite 206, 301 South Fair Oaks Ave, Pasadena, CA, 91105, USA
Authors of medical publications rarely provide their readers with the full raw data from their work but provide only the summarised statistical analysis. Indeed, publishing the raw data in a paper journal would usually be impractical and of little help to readers as transcription from the printed paper to a computer for further analysis would be la...
OBJECTIVE To determine if ultrasound during pregnancy is associated with non-right handedness in children. DESIGN Meta-analysis of follow-up studies of randomized controlled trials. DATA SOURCES Literature search. STUDY SELECTION The meta-analysis included two long-term follow-up studies of the children born to women who had been enrolled in three...
To investigate how accurately practicing obstetricians (experts) can apply dating rules and compare the interpretation of gestation-sensitive ultrasound data with those of a computer system.
Seventeen practicing obstetricians. Members of the Royal College of Obstetricians and Gynaecologists, from 14 different units throughout the UK.
Six cases with...
Editor—Miscarriage is distressing, giving rise to a range of emotional experiences for both the woman and her partner. The aim of medical and nursing staff must be to reduce distress, but the distress may be increased by staff taking the wrong approach or using inappropriate terminology. The lay public tend to interpret an “abortion” as a terminati...
A search of the two major journals of obstetrics and gynecology published in the United States has shown that the word abortion rather than miscarriage to describe early pregnancy loss is 6 times more likely to be used compared with most other English language journals over the last 5 years. The use of miscarriage, with descriptive adjectives such...
The expected date of delivery (EDD) using a precise ultrasound day rule was compared with the scan EDD alone in 219 singleton pregnant women who were certain of their last menstrual period, and booked in the obstetric department of a district general hospital. The system compared the ultrasound biometric measurement with the normal range of a publi...
The high cost of disposable stapling devices for laparoscopic-assisted vaginal hysterectomy and bilateral salpingo-oo¨phorectomy (LAVH and BSO) limits the cost effectiveness of the technique. A suture technique is described and the results of the first 45 cases reported. A mean length of postoperative stay of 4 days and an overall complication rate...