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

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Re: umbilical cord cutting -- Follow up question

From: AMD (anonymous@obgyn.net)
Thu, 29 Apr 1999 12:12:19 -0500 (CDT)

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In reply to: kotdawala: "Re: umbilical cord cutting -- Follow up question"

At Thu, 29 Apr 1999, kotdawala wrote: >
>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
>

How do you know if there is ABO incompatibility until the baby is born, typed, and Coombs is done? I am not familiar with the IgG titre -- is that based on amnio or cord sampling or something else? Under what circumstances would you screen for ABO compatibility before birth?

Andrea

Next message: KH: "Softmarkers on Ultrasound"
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In reply to: kotdawala: "Re: umbilical cord cutting -- Follow up question"

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