Rethinking placental transfusion and cord clamping issues

A brief delay in clamping the umbilical cord results in a placental transfusion that supplies the infant with a major source of iron during the first few months of life. Cord circulation continues for several minutes after birth and placental transfusion results in approximately 30% more blood volum...

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Bibliographic Details
Published inThe Journal of perinatal & neonatal nursing Vol. 26; no. 3; p. 202
Main Authors Mercer, Judith S, Erickson-Owens, Debra A
Format Journal Article
LanguageEnglish
Published United States 01.07.2012
Subjects
Anemia, Neonatal - prevention & control
Blood Gas Analysis
Constriction
Evidence-Based Medicine
Female
Fetal Blood - chemistry
Humans
Infant, Newborn
Male
Neonatal Nursing - methods
Placental Circulation - physiology
Pregnancy
Pregnancy Outcome
Premature Birth - prevention & control
Safety Management
Time Factors
Umbilical Cord - blood supply
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Summary:A brief delay in clamping the umbilical cord results in a placental transfusion that supplies the infant with a major source of iron during the first few months of life. Cord circulation continues for several minutes after birth and placental transfusion results in approximately 30% more blood volume. Gravity influences the amount of placental transfusion that an infant receives. Placing the infant skin-to-skin requires a longer delay of cord clamping (DCC) than current recommendations. Uterotonics are not contraindicated with DCC. Cord milking is a safe alternative to DCC when one must cut the cord prematurely. Recent randomized controlled trials demonstrate benefits for term and preterm infants from DCC. The belief that DCC causes hyperbilirubinemia or symptomatic polycythemia is unsupported by the available research. Delay of cord clamping substantively increases iron stores in early infancy. Inadequate iron stores in infancy may have an irreversible impact on the developing brain despite oral iron supplementation. Iron deficiency in infancy can lead to neurologic issues in older children including poor school performance, decreased cognitive abilities, and behavioral problems. The management of the umbilical cord in complex situations is inconsistent between birth settings. A change in practice requires collaboration between all types of providers who attend births.
ISSN:1550-5073
DOI:10.1097/JPN.0b013e31825d2d9a