PREGNANCY-BIRTH Messages for April, 1999: Re: umbilical cord cutting -- Follow up question

Re: umbilical cord cutting -- Follow up question

From: kotdawala (anonymous@obgyn.net)
Thu, 29 Apr 1999 10:51:49 -0500 (CDT)

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At Wed, 28 Apr 1999, AMD wrote: >
>I have also heard that there may be some benefit of cutting the cord
>immediately for babies at risk for ABO incompatibility. Something about
>minimizing the number of the mother's RBC's transferred to the baby and
>reducing the risk of hemolysis.
>
>Is there any truth to this? Should this be discussed with the OB prior
>to delivery?
>
>Thanks,
>Andrea
>
>At Wed, 28 Apr 1999, R. wrote:
>>
>>At Wed, 28 Apr 1999, Laurie wrote:
>>>
>>>I'm looking for the information on immediate umbilical cord
>>>clamping/cutting versus waiting until it stops pulsating. What is the
>>>standard practice and why?
>>
>>This issue has been debated by Obstetricians for years. My conclusion
>>is that it probably doesn't make much difference in the vast majority of
>>cases. In a premature, delaying the clamping may allow an extra largge
>>amount of blood from the cord and placenta to drain into the baby and
>>cause it to have heart failure. At term it makes no real difference. If
>>the baby is in trouble or has meconium present then the cord needs to be
>>clamped and cut right away so that the Pediatricians can do their thing.
>>
>>--
>>R.Daniel Braun, MD FACOG
>>Clinical Professor of Obstetrics and Gynecology
>>Indiana University School of Medicine
>>Indianapolis, IN
>> "Heisenberg might have slept here."
>> Unknown or maybe Indecisive Unknown
>>

As to the query of Andrea, the blood volume of Fetus + Placenta at birth is 450 ml ( a full term baby ) - of which 33% is in placenta. If the cord is clamped immediately we will throw away so much of it. If we keep the baby slightly below thw level of the mother and wait for 3 minutes or for the pulsations to cease, the blood left in placenta will be 7% - in other words we shall give the baby an additional 120 ml of its own blood! This practice may not be advocated in very preterm baby (who cannot handle the load of RBC restucturing), first twin (there may be shared blood supply), known Rh and ABO incompatibility (positive titre of IgG) - where the additional plasma & not the RBCs - will increase the immune reaction, and when early care of child (birth asphyxia) is required. Mothers RBC do not cross the placenta & are not relevent for cord clamping.

--
Kotdawala

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